Check it out.
OP Report.
Through further sharp and blunt dissection utilizing iris scissors, the primary incision was carried deeper to the level of the joint capsule where a capsulotomy was performed through 2 semi-elliptical incisions allowing access to the first MPJ. The ellipsed portion of capsule was passed off for pathological analysisi.
The joint capsule was reflected both dorsally and plantarly therby exposing the hypertrophied medial eminence of the first metatarsal head. At this time, utilizing the pneumatice sagittal saw, the redundant protion of bone along the medial aspect of the metatarsal head was removed and submitted for pathological analysis. Remaining sharp bone edges were then rongeured and finally rasped smooth. The site was copiously irrigated with sterile saline solution.
Following this procedure, a lateral capsulotomy was then performed through an intracapsular approach utilizing a #15 scalpel blade by distracting the hallux. Lastly , the lateral capsule and collateal ligament were freed up with the McGlamry elevator and the fibular sesamoid was released sharpley. Once this was accomplished, the first MPJ was able to be positioned in a more congruous position and the sesmoid apparatus was able to be shifted under the metatarsal head in a more correct alignment.
It could be seen that the hallux was still deviated lateally and therefore the decision was made to perform a closing wedge osteotomy on the proximal phalanx of the hallux. the primary incision was extended with a #15 scalpel blade in a distal fashion thereby exposing more of the base of the hallux which appeared hypertrophied and prominent medially. The incision was deepened down to the bone's cortex. The periosteum was reflected using a periosteal elevator and using the sagittal saw once more, the redundant portion of bone from the base of the phalanx was resected, rongeured and finally rasped smooth.
A closing wedge osteotomy was then performed within th proximal base of the phalanx with the cut made from medial to lateral;
with the base of the closing wedge postioned medially and the apex directed laterally taking precatuions to keep the lateral cortex intact. A 1.5 mm drill hole was effected both proximally and distally to the osteotomy site and #28 gauge monofilament wire was then inserted across the site to secure it utilizing a crochet hook. The free braid was then fished back into the distal drill hole flush to the cortex of the bone. Following this procedure, joint range of motion was found to be adequate, the first MPJ appeared to be in excellent allignment, and the hallux was rendered rectus.
Going off this.
I'm coming up with this.
CPT codes: I've come up with 28298- Phalanx Osteotomy
28306.59- osteotomy, with or without
lengthing, shortening or angular correction
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I know this is a mouth full, but for those who are knowlegeable in this area, share your knowledgle out on this OP report I posed. It will highly be appreciated. I don't take the info I pick up here lightly. You'll be helping me start off in the right direction on these Podiatry Op reports. Learning this all on my own.
Respectfully
Daniel, CPC.
Oh yeah don't be shy to be brutally honest. That's how I learn.
