Here is the op note should this be 28297 or 28740
Attention was directed to the left 1st metatarsal cuneiform joint where a 6 cm linear longitudinal incision was made over the dorsum of the joint. It was just medial to the extensor hallucis longus tendon. This was deepened down to the level of the joint and bone. A linear capsulotomy was performed and the joint capsule and periosteum on the dorsum of the medial cuneiform and 1st metatarsal were reflected medially and laterally completely exposing the joint. At this time a second incision was made down to the level of the 1st webspace in between the 1st and 2nd metatarsal heads. This incision was 3 cm in length. It was deepened bluntly down to the level of the deep transverse metatarsal ligament which was released. The sesamoid suspensory ligament was then released and a lateral capsulotomy was performed. This allowed the 1st metatarsophalangeal joint to open up and the toe to float in a more corrected medial position.
At this point attention was directed back to the 1st metatarsal cuneiform joint. A saw blade with a sagittal saw was used to plane the joint. Once this was done a K-wire was driven into the 1st metatarsal. This was used to translocate the metatarsal more laterally to reduce the intermetatarsal angle and to rotate the metatarsal to reduce the frontal plane deformity along with the shifted plantarly to correct the sagittal plane deformity, so this was a triplanar correction. At this point the cut guide was placed on the dorsum of the joint. Once positioning was verified with the C-arm saw blade was utilized to resect the base of the metatarsal and the distal surface of the cuneiform. All cartilage was then removed from this area of the joint. The joint was distracted for further removal of the joint cartilage. At this point a small stab incision was made just lateral to the 2nd metatarsal through the outrigger. This allowed us to close our correction down and stabilize the site. At this point a medial plate was applied. It was checked with C-arm for good positioning. There was good reduction of deformity. The plate was placed utilizing 2.7 screws. The most distal and most proximal screw was 14 mm. The 2 screws closest to the joint were 12 mm. At this time the distractor was removed and a dorsal plate was placed. Once positioning was completed and the reduction and placement of hardware was confirmed on C-arm the plate was fixated with 2.7 screws. The most distal and most proximal holes were length of 14 screws and the screws closest to the joint spaces were a length of 12. At this point there was good reduction of the deformity.
A splay test was then performed which showed that there was no hypermobility at the mid foot. Once this was completed the instability of the mid foot was noted to be diminished. At this point the K-wire that was used as a joystick on the 1st metatarsal was removed. Three views were taken with C-arm, showed good reduction of deformity, good placement of hardware. Next, the wound was irrigated with copious amounts of normal sterile saline and antibiotic solution.
The incision sites were then closed deeply utilizing 3-0 Vicryl. Then the skin was closed utilizing 4-0 nylon. A postoperative block consisting 0.5% Marcaine plain was then injected. Incision sites were then dressed with sterile compressive dressing consisting of Xeroform, 4x4s, Kerlix and Elastikon tape. Tourniquet was then deflated prompt hyper response was noted to the foot.
Attention was directed to the left 1st metatarsal cuneiform joint where a 6 cm linear longitudinal incision was made over the dorsum of the joint. It was just medial to the extensor hallucis longus tendon. This was deepened down to the level of the joint and bone. A linear capsulotomy was performed and the joint capsule and periosteum on the dorsum of the medial cuneiform and 1st metatarsal were reflected medially and laterally completely exposing the joint. At this time a second incision was made down to the level of the 1st webspace in between the 1st and 2nd metatarsal heads. This incision was 3 cm in length. It was deepened bluntly down to the level of the deep transverse metatarsal ligament which was released. The sesamoid suspensory ligament was then released and a lateral capsulotomy was performed. This allowed the 1st metatarsophalangeal joint to open up and the toe to float in a more corrected medial position.
At this point attention was directed back to the 1st metatarsal cuneiform joint. A saw blade with a sagittal saw was used to plane the joint. Once this was done a K-wire was driven into the 1st metatarsal. This was used to translocate the metatarsal more laterally to reduce the intermetatarsal angle and to rotate the metatarsal to reduce the frontal plane deformity along with the shifted plantarly to correct the sagittal plane deformity, so this was a triplanar correction. At this point the cut guide was placed on the dorsum of the joint. Once positioning was verified with the C-arm saw blade was utilized to resect the base of the metatarsal and the distal surface of the cuneiform. All cartilage was then removed from this area of the joint. The joint was distracted for further removal of the joint cartilage. At this point a small stab incision was made just lateral to the 2nd metatarsal through the outrigger. This allowed us to close our correction down and stabilize the site. At this point a medial plate was applied. It was checked with C-arm for good positioning. There was good reduction of deformity. The plate was placed utilizing 2.7 screws. The most distal and most proximal screw was 14 mm. The 2 screws closest to the joint were 12 mm. At this time the distractor was removed and a dorsal plate was placed. Once positioning was completed and the reduction and placement of hardware was confirmed on C-arm the plate was fixated with 2.7 screws. The most distal and most proximal holes were length of 14 screws and the screws closest to the joint spaces were a length of 12. At this point there was good reduction of the deformity.
A splay test was then performed which showed that there was no hypermobility at the mid foot. Once this was completed the instability of the mid foot was noted to be diminished. At this point the K-wire that was used as a joystick on the 1st metatarsal was removed. Three views were taken with C-arm, showed good reduction of deformity, good placement of hardware. Next, the wound was irrigated with copious amounts of normal sterile saline and antibiotic solution.
The incision sites were then closed deeply utilizing 3-0 Vicryl. Then the skin was closed utilizing 4-0 nylon. A postoperative block consisting 0.5% Marcaine plain was then injected. Incision sites were then dressed with sterile compressive dressing consisting of Xeroform, 4x4s, Kerlix and Elastikon tape. Tourniquet was then deflated prompt hyper response was noted to the foot.