AR2728
Expert
I'm not sure if I'm on the right track with the following op note and reporting 24340. I would really appreciate some feedback!
Once this was done, an approximately 6 cm incision was made 4 cm distal to the crease of the biceps over the radial tuberosity. Once this was done, blunt dissection continued down to the radial tuberosity. Once the radial tuberosity was viewed, there was a stump of the biceps tendon present. This was followed proximally and the biceps tendon was palpated proximal to the elbow crease, however, it was unable to be grasped by the Allis clamp due to its proximal retraction. His second small incision was made in a transverse fashion over the arm proximal to the elbow crease. Dissection continued down and the biceps tendon was then viewed. It was then captured and then pulled into the distal incision. At this point in time, the end of the biceps tendon was then trimmed removing it of the tissue that had been ruptured and fibrosed. The biceps was then trimmed down. At this point in time, Arthrex fiber wire was then used to whipstitch the tendon. A sizer was placed around the tendon and found to be a size 8 mm in diameter. At this point in time, a guide pin was placed over the radial tuberosity. This was viewed under fluoroscopy. The guide pin was placed and it went through both cortices. Once this was done, an 8 mm reamer was then used to penetrate the proximal cortex and just proximal to the posterior cortex. Once this was done, the tight rope button was placed on the tendon. The tight rope button was then placed through the small hole and the posterior aspect of the radius of the button was then flipped. It was checked to ensure that it was flipped which it was. X-rays were taken and it showed the button had flipped. At this point in time, the biceps tendon was then pulled into the reamed out hole in the radial tuberosity. Once this was done, the biceps tendon had been pulled in approximately 8 mm. The tight rope was then tied down. Sutures were cut. The patient had full extension and flexion to 130 degrees and full supination and pronation. Once this was done, the tourniquet was let down, there was no significant bleeding. The wound was copiously irrigated with normal saline removing any excess bone fragments. 3-0 Vicryl suture and 3-0 nylon suture was used to close the subcutaneous tissue and the skin respectively. 30 cc of 0.25% Marcaine plain was injected in the incision site. A sterile soft dressing with Xeroform, 4 x 4...
Once this was done, an approximately 6 cm incision was made 4 cm distal to the crease of the biceps over the radial tuberosity. Once this was done, blunt dissection continued down to the radial tuberosity. Once the radial tuberosity was viewed, there was a stump of the biceps tendon present. This was followed proximally and the biceps tendon was palpated proximal to the elbow crease, however, it was unable to be grasped by the Allis clamp due to its proximal retraction. His second small incision was made in a transverse fashion over the arm proximal to the elbow crease. Dissection continued down and the biceps tendon was then viewed. It was then captured and then pulled into the distal incision. At this point in time, the end of the biceps tendon was then trimmed removing it of the tissue that had been ruptured and fibrosed. The biceps was then trimmed down. At this point in time, Arthrex fiber wire was then used to whipstitch the tendon. A sizer was placed around the tendon and found to be a size 8 mm in diameter. At this point in time, a guide pin was placed over the radial tuberosity. This was viewed under fluoroscopy. The guide pin was placed and it went through both cortices. Once this was done, an 8 mm reamer was then used to penetrate the proximal cortex and just proximal to the posterior cortex. Once this was done, the tight rope button was placed on the tendon. The tight rope button was then placed through the small hole and the posterior aspect of the radius of the button was then flipped. It was checked to ensure that it was flipped which it was. X-rays were taken and it showed the button had flipped. At this point in time, the biceps tendon was then pulled into the reamed out hole in the radial tuberosity. Once this was done, the biceps tendon had been pulled in approximately 8 mm. The tight rope was then tied down. Sutures were cut. The patient had full extension and flexion to 130 degrees and full supination and pronation. Once this was done, the tourniquet was let down, there was no significant bleeding. The wound was copiously irrigated with normal saline removing any excess bone fragments. 3-0 Vicryl suture and 3-0 nylon suture was used to close the subcutaneous tissue and the skin respectively. 30 cc of 0.25% Marcaine plain was injected in the incision site. A sterile soft dressing with Xeroform, 4 x 4...