27610x2 Help HERE IS THE REPORT
Can you post the notes? I haven't seen this done twice on one ankle. Thanks!
PREOPERATIVE DIAGNOSES:
l. POSTTRAUMATIC ARTHRITIS, RIGHT ANKLE, ANTERIOR MEDIAL.
2. POSTTRAUMATIC ARTHRITIS, RIGHT ANKLE, ANTERIOR LATERAL.
OPERATIVE PROCEDURE PERFORMED:
l. Anterior medial ankle arthrotomy.
2. Anterior lateral ankle arthrotomy.
POSTOPERATIVE DIAGNOSES:
l. POSTTRAUMATIC ARTHRITIS, RIGHT ANKLE, ANTERIOR MEDIAL.
2. POSTTRAUMATIC ARTHRITIS, RIGHT ANKLE, ANTERIOR LATERAL.
SURGERY AND FINDINGS:
The patient walked to the OR and was placed on the OR table in a supine
position where general anesthesia was administered and a thigh tourniquet
applied. Two grams of cefazolin was given IV. A 10 mL injection of 1%
lidocaine plain was injected locally and then a sterile prep done on the right
lower extremity.
Anterior medial ankle arthrotomy: An incision was made between the tibialis
anterior and EHL, extensor hallucis longus, tendon over the anterior medial
ankle. The incision was made after the tourniquet was inflated to 280 mmHg.
The tourniquet was eventually deflated at 70 minutes. The incision was
carefully deepened through the subcutaneous tissues where small veins were
cauterized. The tibialis anterior and EHL tendons were retracted medially and
laterally respectively. Careful dissection through the fat layer revealed many
tortuous veins that were hand tied or cauterized. Dissection deepened down to
the joint capsule, which was longitudinally incised and reflected. There was a
profound amount of chronic synovitis that I debrided over the anterior medial
and anterior central ankle joint. I was able to see the significant spurring
beginning centrally at the tibia and then moving laterally where most of the
spurring was noted on the CT scan. There was a dorsal spur on the talar neck
which I resected with rongeur followed by hand rasp. Careful inspection of the
medial gutter revealed no loose bodies or bone spurs and the anterior distal
tibia appeared healthy. I then chose to do the anterior lateral arthrotomy.
With the anterior medial and central ankle joint debrided appropriately, I then
went to the second incision.
Anterior lateral ankle arthrotomy: An incision was made over the anterior
lateral ankle and coursed distal to the sinus tarsi to expose the lateral
process of the talus where there was significant bony impingement with the
fibula. This incision began just distal to the superficial peroneal nerve,
which was palpable just superior and medial to my incision. Careful dissection
through the fat layer revealed many tortuous veins, which is commonly seen in
significant arthritic conditions. The veins were carefully hand tied and/or
cauterized. Dissection deepened down to the joint capsule which was incised
and retracted. There was significant distal tibial spurring over the anterior
lateral tibia, which correlated well to preop x-rays and CT scan. There was
some lateral impingement of the lateral process of the talus, which was quite
hypertrophic as it impinged into the fibula. I had to cut into the ATF
ligament to expose the joint properly. After doing so, I was able to resect
the inferior lateral process of the talus with osteotome followed by a rongeur
and hand rasp. I then used the osteotome and mallet to resect the distal
anterior tibial spurring and took care to protect the talar dome. As expected,
there was significant degradation of the talar dome, but there was still some
viable cartilage, especially centrally and more posteriorly of course. The
anterior lateral talus was more affected than the medial portion. Copious
irrigation was done. I took another FluoroScan at this time showing complete
resection of the distal spurring and dorsal talar neck spurring. Also, the
mortise image showed appropriate remodeling of the hypertrophic lateral talar
process. After a final irrigation, layered closure with 2-0 Vicryl for the
capsule followed by 4-0 Vicryl for subcutaneous closure and 4-0 Prolene for the
skin on both incisions. Now, a 20 mL injection of 0.25% Marcaine plain was
injected locally and then a sterile compressive dressing was applied. A BK
removable boot was applied in recovery. The patient tolerated both procedures
and anesthesia well and will be followed in one week at the Sports Medicine
Clinic. There were no immediate complications.