kellit21
Guru
Can anyone help me code this?
Procedures:
1. Medializing calcaneal osteotomy, left hindfoot
2. Excision of diseased segment and Indian repair of posterior tibial tendon
3. Transfer of flexor digitorum longus tendon to the navicular tuberosity
4. Supplemental repair with fiber tape, "internal splint"
Initial approach was to the lateral calcaneal area through an extensile L-shaped lateral incision with full-thickness subperiosteal flaps elevated. Once we gained access for small Cobra retractors above and below the tuberosity, the calcaneus was sectioned obliquely. The step plate was then put in place on the distal fragment with locking screws. The osteotomy was then advanced medializing the tuberosity for approximately 5mm. Proximal fixation was gained with an interfragmentary compression screw with good purchase followed by a locking plate holding the screws. We did use the C-arm to be sure we were in the subtalar joint. The wound was irrigated and closed with interrupted 2-0 Vicryl and 4-0 nylon.
Attention turned to the medial side of the hindfoot. A longitudinal incision was made along the course of the posterior tibial tendon and down to about mid metatarsal level. Careful dissection with cauterization of the bridging veins was done. The posterior tibial tendon was clearly enlarged and almost palpably calcified for about a 1-cm segment about 2 cm away from its ultimate insertional site. The insertional site itself was somewhat thinned and weekend. This seemed consistent again with a near total avulsion with only a few residual fibers remaining and showing at this point 6+ weekd after injury. Ultimately, we excised the diseased portion of the posterior tibial tendon. The flexor digitorum tendon was identified and traced distally into the knot of Henry. The flexor hallicus and flexor digitorum tendons were then tenodesed distally and the flexor digitorum tendon harvested and brought proximally into the wound. The navicular tuberosity was identified and proven with C-arm. A tunnel was made from plantar to dorsal through the tuberosity with a wide bridge of bone medially. The proximal fixation point for the internal splint was placed in the sustentaculum tali deviatin plantar ward to avoid the subtalar joint. The suture anchor was put in place. The distal 2 tapes of fiber tape material were then passed from one dorsal to plantar, one plantar to dorsal through the navicualr tunnel. The FDL which had been whiped sutured was also passed from platar to dorsal. Fixation here was with interference screw.
All help would be appreciated!!!!
Procedures:
1. Medializing calcaneal osteotomy, left hindfoot
2. Excision of diseased segment and Indian repair of posterior tibial tendon
3. Transfer of flexor digitorum longus tendon to the navicular tuberosity
4. Supplemental repair with fiber tape, "internal splint"
Initial approach was to the lateral calcaneal area through an extensile L-shaped lateral incision with full-thickness subperiosteal flaps elevated. Once we gained access for small Cobra retractors above and below the tuberosity, the calcaneus was sectioned obliquely. The step plate was then put in place on the distal fragment with locking screws. The osteotomy was then advanced medializing the tuberosity for approximately 5mm. Proximal fixation was gained with an interfragmentary compression screw with good purchase followed by a locking plate holding the screws. We did use the C-arm to be sure we were in the subtalar joint. The wound was irrigated and closed with interrupted 2-0 Vicryl and 4-0 nylon.
Attention turned to the medial side of the hindfoot. A longitudinal incision was made along the course of the posterior tibial tendon and down to about mid metatarsal level. Careful dissection with cauterization of the bridging veins was done. The posterior tibial tendon was clearly enlarged and almost palpably calcified for about a 1-cm segment about 2 cm away from its ultimate insertional site. The insertional site itself was somewhat thinned and weekend. This seemed consistent again with a near total avulsion with only a few residual fibers remaining and showing at this point 6+ weekd after injury. Ultimately, we excised the diseased portion of the posterior tibial tendon. The flexor digitorum tendon was identified and traced distally into the knot of Henry. The flexor hallicus and flexor digitorum tendons were then tenodesed distally and the flexor digitorum tendon harvested and brought proximally into the wound. The navicular tuberosity was identified and proven with C-arm. A tunnel was made from plantar to dorsal through the tuberosity with a wide bridge of bone medially. The proximal fixation point for the internal splint was placed in the sustentaculum tali deviatin plantar ward to avoid the subtalar joint. The suture anchor was put in place. The distal 2 tapes of fiber tape material were then passed from one dorsal to plantar, one plantar to dorsal through the navicualr tunnel. The FDL which had been whiped sutured was also passed from platar to dorsal. Fixation here was with interference screw.
All help would be appreciated!!!!