Wiki Was a Capsulotomy Completed?

cclarson

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Hello Everyone,

I just wanted to confirm whether or not this pt op note includes a capsulotomy in the body portion of the report? Sometimes the doctor will word it in a way that I'm not familiar with, and I wanted to know if this was one of those occasions. If it's not mentioned, I'll have the doctor create an addendum. Thank you!

POSTOPERATIVE DIAGNOSES:

1. Painful hammer toe deformity second digit, right foot.
2. Elongated second metatarsal, right foot.
3. Partial dislocation second metatarsophalangeal joint, right foot.

OPERATION PERFORMED:

Hammer toe repair with arthrodesis of the proximal interphalangeal joint, capsulotomy of the metacarpophalangeal joint, and Weil osteotomy of the second metatarsal.

DESCRIPTION OF PROCEDURE:

The patient was brought into the OR and placed supine on the table. General anesthesia was initiated. The right lower extremity was prepped to the knee and draped in the usual sterile fashion. The thigh tourniquet was inflated.

Attention was directed to the second toe. Two converging semi-elliptical were created overlying the PIPJ. A midline incision adjoined this extending proximal to the MPJ. The incision was deepened to deep fascia. The extensor tendon was divided in Z-plasty lengthening fashion. The articular cartilage was resected at the PIPJ on both sides. A Weil osteotomy was created in the second metatarsal to allow the capital fragment to retract proximally. It was fixated with a 13 mm 2.0 twist off screw. The PIP arthrodesis was fixated with a 0.045 smooth K-wire, which was driven from the middle and distal phalanges and retrograded back to the base of the proximal phalanx under fluoroscopic guidance. The long flexor tendon was then harvested from the plantar aspect of the second toe, divided into medial and lateral slips and rerouted dorsally and sutured in the extensor hood mechanism.

Intraoperative x-rays validated satisfactory position of the toe and the internal fixation. The extensor tendon was then repaired in a lengthened fashion with 3-0 Vicryl and the skin was repaired with 4-0 nylon.

The above noted amounts of local anesthetic were then utilized to block the surgical site. The foot was bandaged with Xeroform gauze, dry sterile dressing, Kling, and Coban. The patient left the OR in stable and satisfactory condition. He will be discharged with appropriate instructions and follow up in Dr. Hamilton office next Monday.
 
Are you looking at a capsulotomy for the PIP or MTP? A capsulotomy is part of the hammer toe at the IPJ and would need to be performed in order to perform the metatarsal osteotomy, so it would be bundled with that procedure. Either way the documentation is lacking in this respect. Are you looking at billing it for some reason? ** And just a heads up. When posting surgery questions, it's best to post the complete post op diagnosis and all the procedures performed. This is especially helpful with foot and ankle surgery since procedures can be performed for multiple reasons.
 
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Are you looking at a capsulotomy for the PIP or MTP? A capsulotomy is part of the hammer toe at the IPJ and would need to be performed in order to perform the metatarsal osteotomy, so it would be bundled with that procedure. Either way the documentation is lacking in this respect. Are you looking at billing it for some reason? ** And just a heads up. When posting surgery questions, it's best to post the complete post op diagnosis and all the procedures performed. This is especially helpful with foot and ankle surgery since procedures can be performed for multiple reasons.
I'm looking for the capsulotomy for the MTP. So that would be bundled into the Weil osteotomy then? And yes, this particular doctor's op notes can be lacking. ***And I did post the complete post op diagnosis and all the procedures performed, I always provide all of the necessary information when asking a question. This thin dictation is the reason why I was asking for a 2nd opinion. :)
 
I'm looking for the capsulotomy for the MTP. So that would be bundled into the Weil osteotomy then? And yes, this particular doctor's op notes can be lacking. ***And I did post the complete post op diagnosis and all the procedures performed, I always provide all of the necessary information when asking a question. This thin dictation is the reason why I was asking for a 2nd opinion. :)
That's good to know. Boy you are working with really bad dictation, does not make your job any easier! A capsulotomy must be done at the MTP joint in order to perform the metatarsal osteotomy.
 
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