should both codes be billed 25447,59 and 25332. Please help
I then made a 3 cm longitudinal incision over the first CMC joint. I dissected
down, careful to protect the neurovascular structures. I exposed the interval
between the APL and EPB tendons which I found in the capsule and split
longitudinally and exposed the joint. I removed all soft tissue attachments on
the trapezium, careful to protect the radial artery. I then removed the
trapezium in a piecemeal fashion using an osteotome and a rongeur. I then
reduced the first CMC joint. I brought in fluoroscopy and confirmed reduction
of
the CMC Shenton's line. I then drilled a K-wire with a loop at the end of it
across the base of the first metacarpal staying parallel to the articular
surface, heading obliquely through the base of the second metacarpal. I was
able to achieve bicortical fixation. I then brought in fluoroscopy. I
confirmed
the appropriate K-wire placement. I then made a 1 cm longitudinal incision
over
the dorsal base of the second metacarpal. I dissected down and found the
K-wire. I then affixed a FiberWire with EndoButton on the outer part of the
K-wire and pulled the K-wire through, pulling the FiberWire through the tunnel
over the EndoButton which was affixed on the radial base of the first
metacarpal. I then reduced the joint and tied it down provisionally over
another EndoButton affixed to the dorsal ulnar surface of the second
metacarpal
base. I brought in fluoroscopy. I confirmed the appropriate stability with a
nice reduction and return of Shenton's line. I was happy with the stability.
I
was happy with the thumb opposition. I was happy with the position and
fixation
of the first metacarpal. I then tied further knots and secured the FiberWire
and
buried it underneath the interosseous.
I then examined the thumb. I was very happy with the stability as well as the
position of the thumb as well.
I then made a 3 cm longitudinal incision over the first CMC joint. I dissected
down, careful to protect the neurovascular structures. I exposed the interval
between the APL and EPB tendons which I found in the capsule and split
longitudinally and exposed the joint. I removed all soft tissue attachments on
the trapezium, careful to protect the radial artery. I then removed the
trapezium in a piecemeal fashion using an osteotome and a rongeur. I then
reduced the first CMC joint. I brought in fluoroscopy and confirmed reduction
of
the CMC Shenton's line. I then drilled a K-wire with a loop at the end of it
across the base of the first metacarpal staying parallel to the articular
surface, heading obliquely through the base of the second metacarpal. I was
able to achieve bicortical fixation. I then brought in fluoroscopy. I
confirmed
the appropriate K-wire placement. I then made a 1 cm longitudinal incision
over
the dorsal base of the second metacarpal. I dissected down and found the
K-wire. I then affixed a FiberWire with EndoButton on the outer part of the
K-wire and pulled the K-wire through, pulling the FiberWire through the tunnel
over the EndoButton which was affixed on the radial base of the first
metacarpal. I then reduced the joint and tied it down provisionally over
another EndoButton affixed to the dorsal ulnar surface of the second
metacarpal
base. I brought in fluoroscopy. I confirmed the appropriate stability with a
nice reduction and return of Shenton's line. I was happy with the stability.
I
was happy with the thumb opposition. I was happy with the position and
fixation
of the first metacarpal. I then tied further knots and secured the FiberWire
and
buried it underneath the interosseous.
I then examined the thumb. I was very happy with the stability as well as the
position of the thumb as well.