CCANTER
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I am struggling with this procedure. The surgeon states 28730 x 3. But i think it would be 28740 to cover all three rays that were fused. or possibly 28740 with 28297?
A dorsal incision was made over the 1st and second incision over third tarsometatarsal joints. This was taken with careful dissection, all neurovascular structures were retracted as needed. A periosteal incision was performed over the 1/2/3 TMT joints. The joints were distracted with intermittent pin distraction. The cartilage was curetted off of the area and removed with a rongeur. The subchondral bone was drilled with a 2.0 K wire. Wedge resection of the bases was performed and noted nice rectus metatarsals. Everything was compressed and noted to have good compression on fluoroscopy. Fusion staples were drilled and inserted according affect specifications. These maintain the compression and stability of the 2/3 TMT fusion.
15 blade incision overlying MC joint of right foot. Dissection down to met base and sagital saw used to plane through the joint. Large Steinmann pin used to be radiates into the toe. A large tenaculum was used to anchor the second and first metatarsal heads. This reduced the IM 1/2 angle and sesamoid position. This was checked on fluoroscopy and noted appropriate position. A sagittal saw used to resect the joint removing as little bone as possible. Checked on fluoroscopy and noted appropriate resection of joint. Temporarily fixated with compressor and Steinmann pins. Fixated with 4.0 fusion screw and lapidus plate. Drilled and measured according to manufacturer specifications. Noted good compression. Checked on fluoroscopy and noted rectus metatarsal with appropriate fixation. An incision was made over the lateral side of the first MPJ. This was made a stab and spread technique. Retraction was performed and a release of the lateral collateral ligaments and adductor tendon. Capsular Incision made at the head of the metatarsals and approximately 3 mm medial eminence was removed. This was rasped free of any sharp edges. This copiously irrigated and closed with 2-0 Vicryl with aggressive capsulorrhaphy. This noted and reduced the hallux abduction. Evidence closed with 3.0 Monocryl/4.0 nylon in layer technique.
Copiously irrigated and closed with 3-0 monocryl/3-0 Nylon.
A dorsal incision was made over the 1st and second incision over third tarsometatarsal joints. This was taken with careful dissection, all neurovascular structures were retracted as needed. A periosteal incision was performed over the 1/2/3 TMT joints. The joints were distracted with intermittent pin distraction. The cartilage was curetted off of the area and removed with a rongeur. The subchondral bone was drilled with a 2.0 K wire. Wedge resection of the bases was performed and noted nice rectus metatarsals. Everything was compressed and noted to have good compression on fluoroscopy. Fusion staples were drilled and inserted according affect specifications. These maintain the compression and stability of the 2/3 TMT fusion.
15 blade incision overlying MC joint of right foot. Dissection down to met base and sagital saw used to plane through the joint. Large Steinmann pin used to be radiates into the toe. A large tenaculum was used to anchor the second and first metatarsal heads. This reduced the IM 1/2 angle and sesamoid position. This was checked on fluoroscopy and noted appropriate position. A sagittal saw used to resect the joint removing as little bone as possible. Checked on fluoroscopy and noted appropriate resection of joint. Temporarily fixated with compressor and Steinmann pins. Fixated with 4.0 fusion screw and lapidus plate. Drilled and measured according to manufacturer specifications. Noted good compression. Checked on fluoroscopy and noted rectus metatarsal with appropriate fixation. An incision was made over the lateral side of the first MPJ. This was made a stab and spread technique. Retraction was performed and a release of the lateral collateral ligaments and adductor tendon. Capsular Incision made at the head of the metatarsals and approximately 3 mm medial eminence was removed. This was rasped free of any sharp edges. This copiously irrigated and closed with 2-0 Vicryl with aggressive capsulorrhaphy. This noted and reduced the hallux abduction. Evidence closed with 3.0 Monocryl/4.0 nylon in layer technique.
Copiously irrigated and closed with 3-0 monocryl/3-0 Nylon.