pip joint resection????


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needing to know what you would code for the pip joint resection???

Right foot claw toes numbers 2, 3, and 4, with bunionette deformity of the right fifth toe.

POSTOPERATIVE DIAGNOSIS: Right foot claw toes numbers 2, 3, and 4, with bunionette deformity of the right fifth toe.

PROCEDURE: Extensor tendon lengthening of the extensor digitorum communis toes 2, 3, and 4, dorsal capsulotomies of second, third, and fourth metatarsophalangeal joints, PIP joint arthrodesis of second, third, and fourth toes, fifth metatarsal osteotomy, and bunionette resection of fifth toe.





INDICATIONS: This is a 49-year-old woman with a painful right forefoot deformity as outlined above. She had failed conservative care and is brought to the operating room for surgical correction of the deformity. Informed consent was obtained prior to coming to the operating room.

DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and placed supine on the operating room table. General anesthetic was administered by the Anesthesia Department and 1 gram of Kefzol was administered intravenously prior to beginning the procedure. Tourniquet was placed on the right calf. The foot was prepped and draped in the usual sterile fashion, exsanguinated with an Esmarch, and the tourniquet inflated to 250 mmHg. The extensor digitorum communis to the second, third, fourth, and fifth toes was found to be extremely tight, causing hyperextension of the metatarsophalangeal joints. A 2-cm incision was made over the dorsolateral ankle. The EDC tendons were identified and Z-lengthening of the tendons for the second, third, fourth, and fifth toes was performed through this incision, allowing some improvement of the hyperextension deformity at the MTP joints. An incision was made on the second toe beginning at DIP joint, extending proximally to the MP joint, carried down sharply through skin, subcutaneous tissues, and down to the flexor tendon sheath. The FDL tendon was released from its insertion at the base of distal phalanx. The flexor brevis tendon was released from the base of the middle phalanx. A PIP joint resection was performed through the same incision. The metatarsophalangeal joint capsular incision was made for a capsular release. This corrected the deformity of the second toe, which was then pinned with a K-wire exiting the tip of the toe and extending proximally across the DIP, PIP, and MP joints. An elliptical incision was then made over the PIP joints of the third and fourth toes and carried down through the extensor mechanism. The collateral ligaments were released and the PIP joint was resected. Dorsal capsulotomy incisions were made at the metatarsophalangeal joints and the hyperflexion deformity was well reduced. These toes were pinned with 0.045 K-wires exiting the tip of the toes and crossing the MP joints, holding the toes in neutral position. Incision was made on the lateral aspect of the fifth metatarsal, beginning at the metatarsophalangeal joint and extending proximally to the mid-shaft, carried down sharply through skin and subcutaneous tissues, and then directly on to the dorsolateral cortex of the metatarsal shaft. An osteotomy was performed with a sagittal saw, and this was performed in the coronal plane. The valgus malalignment of the metatarsal was then reduced and the osteotomy was fixed in its reduced position with a 2.4 cortical screw placed in lag fashion, in the usual AO technique. The bunionette deformity was resected with a sagittal saw at the lateral aspect of the fifth metatarsal head, resected in the lateral eminence. The C-arm was draped and moved into position, and the deformity was found to be satisfactorily corrected with satisfactory position of the hardware. All wounds were irrigated and closed with 3-0 Vicryl in the subcutaneous tissues and 4-0 nylon in the skin. An ankle block was performed with 0.5% plain Marcaine. The wound was dressed with Adaptic, dry sterile dressings, and a Coban wrap. A postoperative shoe was applied to the foot. The tourniquet was deflated. Patient was awakened and transferred to the recovery room in good condition, having tolerated the procedure well