jrs3181
Contributor
OK... So I have determined to use 25320 for the Left scapholunate interossous ligament repair. What about the other code?
TIA!!
PREOPERATIVE DIAGNOSES:
1. Left radial styloid fracture.
2. Left scapholunate interosseous ligament tear with DISI deformity.
POSTOPERATIVE DIAGNOSES:
1. Left radial styloid fracture.
2. Left scapholunate interosseous ligament tear with DISI deformity.
PROCEDURES:
1. Left scapholunate interosseous ligament repair.
2. Left wrist posterior interosseous neurectomy.
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: Less than 5 cc.
SPECIMENS: None.
DRAINS: None.
COMPLICATIONS: None.
DISPOSITION: Stable to the postanesthesia care unit. The patient will be discharged to home today.
INDICATIONS FOR PROCEDURE: 51-year-old female, who had a fall from a height at her place of employment, injuring her left upper extremity. She was evaluated on an outpatient basis and found to have a radial styloid fracture and also a tear of her left scapholunate interosseous ligament with dorsal intercalated segmental instability of her wrist. I discussed the risks, benefits, and alternatives to the aforementioned procedures and she elected to proceed. The patient provided informed consent for this procedure prior to the surgery.
DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative holding area, and the left upper extremity was marked with a skin marker to identify as correct surgical site. The patient was brought back to the operating room and placed supine on the operating room table with the left upper extremity extended on a hand table. A tourniquet was placed to the left arm. General endotracheal anesthesia was induced by the anesthesia provider. The left upper extremity was prepped and draped in the usual sterile fashion.
We exsanguinated the limb and inflated the tourniquet. We used a standard longitudinal dorsal approach to the wrist first by making a longitudinal skin incision centered over the Lister’s tubercle. We used Bovie electrocautery for hemostasis. We used blunt dissection until we encountered the tendons of the fourth dorsal extensor compartment. We identified the posterior interosseous nerve and performed a PIN neurectomy. We used Bovie electrocautery to cauterize the proximal in an attempt to prevent neuroma formation.
Next, we made a radial-based capsulotomy using sharp dissection to elevate the capsule dorsally and ulnarly from the carpus. Once we had done this, we identified the scaphoid and the lunate. There was an obvious gap in between them with a tear of the scapholunate interosseous ligament that had torn off of the lunate.
We placed two K-wires, one each in the lunate and scaphoid to act as Joystick for reduction of the scapholunate widening and correction of the DISI deformity. We used intraoperative fluoroscopy to confirm this and it was found to be satisfactory. We selected another K-wire and placed it across the scaphoid into the lunate. We then placed another K-wire from the scaphoid into the capitate. We confirmed positioning of these implants as well as maintenance of reduction of the scapholunate interval as well as correction of the DISI deformity and this was all found to be satisfactory. The two K-wires that were placed across the carpus, were cut deep to the skin.
Next, we selected a Biomet JuggerKnot anchor for repair of the ligament. The anchor was placed into the lunate and the suture passed through the interosseous ligament and the repair was performed.
We removed the Joystick K-wires. We irrigated the wound and dried it. We repaired the capsule as well as the extensor retinaculum over the fourth compartment using interrupted 4-0 Monocryl sutures. We then closed the skin using inverted subcuticular 2-0 Vicryl sutures, followed by a running subcuticular 4-0 Monocryl suture.
We used a total of 10 cc of 0.5% Marcaine injected into the subcutaneous tissue surrounding the incision. We cleansed and dried the wounds. We placed sterile dressing consisting of Steri-Strips, followed by Adaptic, followed by gauze sponges, sterile cast padding, and a well-padded splint with a dorsal and volar slab of plaster.
We deflated the tourniquet. The patient was awakened from anesthesia by the anesthesia provider. She was transferred to her hospital bed and then transferred to the postanesthesia care unit in a stable condition.
TIA!!
PREOPERATIVE DIAGNOSES:
1. Left radial styloid fracture.
2. Left scapholunate interosseous ligament tear with DISI deformity.
POSTOPERATIVE DIAGNOSES:
1. Left radial styloid fracture.
2. Left scapholunate interosseous ligament tear with DISI deformity.
PROCEDURES:
1. Left scapholunate interosseous ligament repair.
2. Left wrist posterior interosseous neurectomy.
ANESTHESIA: General endotracheal anesthesia.
ESTIMATED BLOOD LOSS: Less than 5 cc.
SPECIMENS: None.
DRAINS: None.
COMPLICATIONS: None.
DISPOSITION: Stable to the postanesthesia care unit. The patient will be discharged to home today.
INDICATIONS FOR PROCEDURE: 51-year-old female, who had a fall from a height at her place of employment, injuring her left upper extremity. She was evaluated on an outpatient basis and found to have a radial styloid fracture and also a tear of her left scapholunate interosseous ligament with dorsal intercalated segmental instability of her wrist. I discussed the risks, benefits, and alternatives to the aforementioned procedures and she elected to proceed. The patient provided informed consent for this procedure prior to the surgery.
DESCRIPTION OF PROCEDURE: The patient was identified in the preoperative holding area, and the left upper extremity was marked with a skin marker to identify as correct surgical site. The patient was brought back to the operating room and placed supine on the operating room table with the left upper extremity extended on a hand table. A tourniquet was placed to the left arm. General endotracheal anesthesia was induced by the anesthesia provider. The left upper extremity was prepped and draped in the usual sterile fashion.
We exsanguinated the limb and inflated the tourniquet. We used a standard longitudinal dorsal approach to the wrist first by making a longitudinal skin incision centered over the Lister’s tubercle. We used Bovie electrocautery for hemostasis. We used blunt dissection until we encountered the tendons of the fourth dorsal extensor compartment. We identified the posterior interosseous nerve and performed a PIN neurectomy. We used Bovie electrocautery to cauterize the proximal in an attempt to prevent neuroma formation.
Next, we made a radial-based capsulotomy using sharp dissection to elevate the capsule dorsally and ulnarly from the carpus. Once we had done this, we identified the scaphoid and the lunate. There was an obvious gap in between them with a tear of the scapholunate interosseous ligament that had torn off of the lunate.
We placed two K-wires, one each in the lunate and scaphoid to act as Joystick for reduction of the scapholunate widening and correction of the DISI deformity. We used intraoperative fluoroscopy to confirm this and it was found to be satisfactory. We selected another K-wire and placed it across the scaphoid into the lunate. We then placed another K-wire from the scaphoid into the capitate. We confirmed positioning of these implants as well as maintenance of reduction of the scapholunate interval as well as correction of the DISI deformity and this was all found to be satisfactory. The two K-wires that were placed across the carpus, were cut deep to the skin.
Next, we selected a Biomet JuggerKnot anchor for repair of the ligament. The anchor was placed into the lunate and the suture passed through the interosseous ligament and the repair was performed.
We removed the Joystick K-wires. We irrigated the wound and dried it. We repaired the capsule as well as the extensor retinaculum over the fourth compartment using interrupted 4-0 Monocryl sutures. We then closed the skin using inverted subcuticular 2-0 Vicryl sutures, followed by a running subcuticular 4-0 Monocryl suture.
We used a total of 10 cc of 0.5% Marcaine injected into the subcutaneous tissue surrounding the incision. We cleansed and dried the wounds. We placed sterile dressing consisting of Steri-Strips, followed by Adaptic, followed by gauze sponges, sterile cast padding, and a well-padded splint with a dorsal and volar slab of plaster.
We deflated the tourniquet. The patient was awakened from anesthesia by the anesthesia provider. She was transferred to her hospital bed and then transferred to the postanesthesia care unit in a stable condition.