ortho1991
Guru
Hi All,
I hope someone can help.
I am looking for the code for ORIF coracod scapular. Any help or suggestions will be appreicated. Here is the op-note.
A deltopectoral approach
was then made for the coracoid process distally around 10 cm. Dissection taken
down to the cephalic vein which was retracted laterally. The conjoin tendon was
identified. It was not avulsed, however you could feel the fractured tip of the
coracoid within this but the soft tissue envelope including the CA ligament was
still intact. I then subsequently placed my retractor around this. I kept it as
high as possible. I then identified the proximal humerus. I then released the
remainder of the subscapularis which was essentially gone. The entire supra-
spinatus, infraspinatus was gone. Essentially the teres minor was gone as well.
I then delivered the humerus out of the wound. I then placed my Tornier intra-
medullary guide, marked this and then used my osteotomy oscillating saw to cut
my osteotomy. I then subsequently templated and then felt that the 12 mm stem
would be the most appropriate. I then retracted the humerus posteriorly and
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then identified the glenoid itself. I then used the long tip Bovie, released
the labrum circumferentially and then placed a 29 mm base plate by first marking
my center hole trying to get as low in the glenoid as possible. I then drilled,
reamed with my smaller reamer and then hand reamed and then subsequently placed
my larger reamer and then impacted the base plate into the stable glenoid. I
then placed my anterior and posterior compression screws, inferior locking
screws, superior locking screw and then irrigated copiously with a pulse lavage
and antibiotic solution.
I then subsequently impacted the 36 mm plus 10 degree Glenosphere and then
locked this in place. Once this was placed and the humerus was then identified
I then used my power reamer followed by my metaphyseal _____ hammer reamer and
then broached and then placed a 12 36 mm metaphyseal fragment and placed this
at appropriate height. I then used a 9 mm plastic trial and then trialed this
for the stability and the tension on the soft tissue. Based on this I
established my height just above my osteotomy cut. I then placed a distal
cement restrictor.
I then filled in a retrograde fashion my canal with Palacos antibiotic cement
and then impacted my prosthesis into place and all excess cement was then
removed. I held this in the appropriate height and version. I then subsequently
trialed and felt that the 9 mm polyethylene was the appropriate tension, there-
fore this was then impacted in place and the joint was reduced. Almost three
liters of irrigation was then performed using the antibiotic solution. From
here I palpated the coracoid process. I then did a slight split within the
conjoin tendon, did not take down the CA ligament. I was able to identify the
base of the coracoid process. It was somewhat fragmented. I tried to template
to consider trying to place an anchor down but I felt that it was too fragmented
to place an anchor. Therefore I then from up top placed a drill hole and then
a whip stitch in the upper portion of the conjoin tendon, two #2 Orthocords
and then brought this through the drill hole through the base of the coracoid
process advancing this as high up as possible without trying to denude the
entire coracoid and take down the entire conjoin tendon and the CA ligament.
This was then almost figure of eight whipped to get this as high and stabilized
and regain tension on the conjoin tendon. From here I then irrigated copiously
once again. I closed my deltopectoral interval with #1 Vicryl followed by
closure of the skin with #3-0 Monocryl, #3-0 Vicryl and #4-0 Monocryl.
I hope someone can help.
I am looking for the code for ORIF coracod scapular. Any help or suggestions will be appreicated. Here is the op-note.
A deltopectoral approach
was then made for the coracoid process distally around 10 cm. Dissection taken
down to the cephalic vein which was retracted laterally. The conjoin tendon was
identified. It was not avulsed, however you could feel the fractured tip of the
coracoid within this but the soft tissue envelope including the CA ligament was
still intact. I then subsequently placed my retractor around this. I kept it as
high as possible. I then identified the proximal humerus. I then released the
remainder of the subscapularis which was essentially gone. The entire supra-
spinatus, infraspinatus was gone. Essentially the teres minor was gone as well.
I then delivered the humerus out of the wound. I then placed my Tornier intra-
medullary guide, marked this and then used my osteotomy oscillating saw to cut
my osteotomy. I then subsequently templated and then felt that the 12 mm stem
would be the most appropriate. I then retracted the humerus posteriorly and
------------------------------------------------------------------------------
then identified the glenoid itself. I then used the long tip Bovie, released
the labrum circumferentially and then placed a 29 mm base plate by first marking
my center hole trying to get as low in the glenoid as possible. I then drilled,
reamed with my smaller reamer and then hand reamed and then subsequently placed
my larger reamer and then impacted the base plate into the stable glenoid. I
then placed my anterior and posterior compression screws, inferior locking
screws, superior locking screw and then irrigated copiously with a pulse lavage
and antibiotic solution.
I then subsequently impacted the 36 mm plus 10 degree Glenosphere and then
locked this in place. Once this was placed and the humerus was then identified
I then used my power reamer followed by my metaphyseal _____ hammer reamer and
then broached and then placed a 12 36 mm metaphyseal fragment and placed this
at appropriate height. I then used a 9 mm plastic trial and then trialed this
for the stability and the tension on the soft tissue. Based on this I
established my height just above my osteotomy cut. I then placed a distal
cement restrictor.
I then filled in a retrograde fashion my canal with Palacos antibiotic cement
and then impacted my prosthesis into place and all excess cement was then
removed. I held this in the appropriate height and version. I then subsequently
trialed and felt that the 9 mm polyethylene was the appropriate tension, there-
fore this was then impacted in place and the joint was reduced. Almost three
liters of irrigation was then performed using the antibiotic solution. From
here I palpated the coracoid process. I then did a slight split within the
conjoin tendon, did not take down the CA ligament. I was able to identify the
base of the coracoid process. It was somewhat fragmented. I tried to template
to consider trying to place an anchor down but I felt that it was too fragmented
to place an anchor. Therefore I then from up top placed a drill hole and then
a whip stitch in the upper portion of the conjoin tendon, two #2 Orthocords
and then brought this through the drill hole through the base of the coracoid
process advancing this as high up as possible without trying to denude the
entire coracoid and take down the entire conjoin tendon and the CA ligament.
This was then almost figure of eight whipped to get this as high and stabilized
and regain tension on the conjoin tendon. From here I then irrigated copiously
once again. I closed my deltopectoral interval with #1 Vicryl followed by
closure of the skin with #3-0 Monocryl, #3-0 Vicryl and #4-0 Monocryl.