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Wondering if I need to use an unlisted code for the pinning? and if I do, what do I compare it to? any help would be appreciated!!!
PREOPERATIVE DIAGNOSIS:
1. right wrist scapholunate ligament tear (acute)
2. Right wrist TFCC tear
POSTOPERATIVE DIAGNOSIS:
1. Right wrist grade 2 scapholunate ligament tear
2. Right wrist grade 1A central TFCC tear
PROCEDURE:
1. right wrist diagnostic arthroscopy
2. Arthroscopic debridement of the scapholunate interosseous ligament
3. Arthroscopic debridement of the central TFCC tear
4. Percutaneous pinning of the scaphoid to lunate
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room. After adequate anesthesia was obtained, the right arm was prepped and draped in a sterile fashion. A procedural pause was performed. The patient was given preoperative IV antibiotics. An exam under anesthesia was performed. There was a palpable click with Watson's maneuver. Fluoroscopy showed slight widening of the SL interval with ulnar deviation. The DRUJ was stable to stressing in neutral, pronation and supination. The right arm was exsanguinated and tourniquet inflated to 250 mmHg. The index and long fingers were placed into finger traps. The arm was suspended in the Linvatec tower. Standard 3-4 and 4-5 portal's were established after insufflating the radiocarpal joint with 5 mL of normal saline. An 11 blade was used and transverse incisions were created just through the skin. A hemostat was used to spread to the soft tissues and entered the radiocarpal joint. A diagnostic arthroscopy was performed from the radiocarpal joint. This showed tearing of the scapholunate interosseous ligament. There was no visible step-off between the scaphoid and lunate. No sign of articular damage. The scope was advanced to the ulnar side of the wrist where a central TFCC tear was identified. This was hemorrhagic. A probe was used and the TFCC was found to be firmly attached to the fovea. There is no sign of UT split tear. At this point, a 2. 9 mm Linvatec shaver was introduced and the 4-5 portal and the frayed SLIL ligament was debrided. The central TFCC tear was also debrided back to healthy tissue. The probe was then again inserted and the TFCC was firmly attached to the fovea. At this point, radial and ulnar midcarpal portals were established. Diagnostic midcarpal arthroscopy showed slight step-off between the scaphoid and lunate. The 3 mm probe was able to be advanced between the scaphoid and lunate but unable to be turned, making this a grade 2 tear. The lunotriquetral interval was tight as was the capitohamate interval.
At this point, the arthroscopic equipment was withdrawn. Given that this was a grade 2 SL injury, I decided to proceed with pinning only. A 1 cm incision was created just distal to the tip of the radial styloid. Blunt dissection was carried down to the capsule in order to protect the superficial nerves. Under fluoroscopic guidance, two 045 K wires were placed from the scaphoid across the lunate. Fluoroscopic images were taken to show reduction of the scapholunate interval and no increase in the scapholunate angle on the lateral, no sign of DISI. The pins were trimmed just beneath the skin. The tourniquet was deflated hemostasis obtained using bipolar cautery. A vein in the 4-5 portal was tied off using 3-0 silk. The portal sites as well as the small radial incision was closed using 4-0 nylon. A sterile dressing followed by a sugar tong thumb spica splint was applied.
PREOPERATIVE DIAGNOSIS:
1. right wrist scapholunate ligament tear (acute)
2. Right wrist TFCC tear
POSTOPERATIVE DIAGNOSIS:
1. Right wrist grade 2 scapholunate ligament tear
2. Right wrist grade 1A central TFCC tear
PROCEDURE:
1. right wrist diagnostic arthroscopy
2. Arthroscopic debridement of the scapholunate interosseous ligament
3. Arthroscopic debridement of the central TFCC tear
4. Percutaneous pinning of the scaphoid to lunate
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room. After adequate anesthesia was obtained, the right arm was prepped and draped in a sterile fashion. A procedural pause was performed. The patient was given preoperative IV antibiotics. An exam under anesthesia was performed. There was a palpable click with Watson's maneuver. Fluoroscopy showed slight widening of the SL interval with ulnar deviation. The DRUJ was stable to stressing in neutral, pronation and supination. The right arm was exsanguinated and tourniquet inflated to 250 mmHg. The index and long fingers were placed into finger traps. The arm was suspended in the Linvatec tower. Standard 3-4 and 4-5 portal's were established after insufflating the radiocarpal joint with 5 mL of normal saline. An 11 blade was used and transverse incisions were created just through the skin. A hemostat was used to spread to the soft tissues and entered the radiocarpal joint. A diagnostic arthroscopy was performed from the radiocarpal joint. This showed tearing of the scapholunate interosseous ligament. There was no visible step-off between the scaphoid and lunate. No sign of articular damage. The scope was advanced to the ulnar side of the wrist where a central TFCC tear was identified. This was hemorrhagic. A probe was used and the TFCC was found to be firmly attached to the fovea. There is no sign of UT split tear. At this point, a 2. 9 mm Linvatec shaver was introduced and the 4-5 portal and the frayed SLIL ligament was debrided. The central TFCC tear was also debrided back to healthy tissue. The probe was then again inserted and the TFCC was firmly attached to the fovea. At this point, radial and ulnar midcarpal portals were established. Diagnostic midcarpal arthroscopy showed slight step-off between the scaphoid and lunate. The 3 mm probe was able to be advanced between the scaphoid and lunate but unable to be turned, making this a grade 2 tear. The lunotriquetral interval was tight as was the capitohamate interval.
At this point, the arthroscopic equipment was withdrawn. Given that this was a grade 2 SL injury, I decided to proceed with pinning only. A 1 cm incision was created just distal to the tip of the radial styloid. Blunt dissection was carried down to the capsule in order to protect the superficial nerves. Under fluoroscopic guidance, two 045 K wires were placed from the scaphoid across the lunate. Fluoroscopic images were taken to show reduction of the scapholunate interval and no increase in the scapholunate angle on the lateral, no sign of DISI. The pins were trimmed just beneath the skin. The tourniquet was deflated hemostasis obtained using bipolar cautery. A vein in the 4-5 portal was tied off using 3-0 silk. The portal sites as well as the small radial incision was closed using 4-0 nylon. A sterile dressing followed by a sugar tong thumb spica splint was applied.