lapinsk62
New
I need help with this * LAPIPLASTY RIGHT FOOT , WEIL OSTEOTOMY RIGHT FOOT SECOND METATARSAL...I am struggling with the lapiplasty procedure. Prior to making incision the first tarsometatarsal joint was identified under fluoroscopy and we also used fluoroscopy to outline placement of the cut guide. We then utilized skin marker to draw out our incisions. The right lower extremity is then elevated and exsanguinated with Esmarch bandage and the pneumatic ankle tourniquet was inflated and the Esmarch bandage removed and the right lower extremity return to operating table. Attention was then turned our attention to the dorsal aspect of the first tarsometatarsal joint where we made a linear longitudinal incision just medial to extensor hallucis longus tendon. Sharp dissection was utilized for the skin and a combination of sharp and blunt dissection was utilized for the subcutaneous tissue. Care was taken to protect and retract all neurovascular structures. Electrocautery was utilized to cauterize all bleeders. The base of first metatarsal and distal aspect of the medial cuneiform was then dissected free of all soft tissue attachments. We then performed a lateral release consisting of a lateral capsulotomy, abductor hallucis tendon release and fibular suspensory ligament release. The hallux was then sitting in a more rectus position. This incision then flushed copious amounts normal sterile saline. Attention was then directed back to the first tarsometatarsal joint we then utilized a sagittal saw to plane the joint. We then inserted K wire into the base of the first metatarsal from medial lateral to allow for frontal plane correction of the deformity. Then we made a stab incision on the dorsal lateral aspect of the second tarsal neck. Sharp dissection was utilized for skin. We then fully dissected to the lateral aspect of the second metatarsal. We then applied the intermetatarsal clamp over the first and second metatarsals. We then placed the fulcrum just lateral to the base of first metatarsal. With the deformity corrected all 3 planes and the hallux dorsiflexed we tightened the intermetatarsal clamp. Appropriate correction of the bunion was confirmed via fluoroscopy. We then placed the joint seeker to the first tarsometatarsal joint. We then pinned the first metatarsal to the second metatarsal through the intermetatarsal clamp and applied the cut guide. Appropriate alignment was confirmed via fluoroscopy. We then utilized a sagittal saw to resect the wafer of bone with articular cartilage from the base of first metatarsal and distal aspect of the medial cuneiform. We then removed the cut guide and temporary wires the intermetatarsal clamp was left in-place holding the IM correction. We then applied the joint distractor and distracted the joint. We removed the wafers of bone and articular cartilage. We utilized a curette to remove all remaining articular cartilage from the joint. The incision then flushed copious nonsterile sterile saline. We fenestrated the first tarsometatarsal joint with a 2.0 mm drill bit. We then compressed the joint with the joint compressor. The joint was temporarily fixated with 1 crossing olive wire. Appropriate correction of the bone in all 3 planes was confirmed via fluoroscopy. We then utilized two Treace medical 4-hole plates with 1 dorsal and 1 medial over the first tarsometatarsal joint. We utilized intraoperative fluoroscopy to confirm appropriate alignment of the hardware. These were drilled and filled with 2.7 mm fully threaded locking screws. Appropriate alignment of the hardware was confirmed via fluoroscopy.
