Good Afternoon,

Need some help on the above procedure. My thoughts 28296, 28313, 28270? Thanks in advance for your help.

Attention was directed to the dorsal aspect of the right foot over the first metatarsophalangeal joint where an incision was created. Dissection was carried through subcutaneous layers. Blood vessels encountered were cauterized. Scar tissue was encountered medially and laterally. Dissection was carried down to the level of the joint capsule. The joint capsule was incised through a T-shaped capsulotomy medially. The lateral joint capsule was exposed but not incised. This would be corrected via a plication procedure later on. The extensor tendon was noted to be extremely tight, therefore a long V-lengthening type procedure was performed in the tendon to facilitate correction. After lateral tightening of the joint capsule, medial joint release and extensor tendon lengthening the deformity was still present. Therefore it was decided that a reverse osteotomy would be performed.

The 0.062 K-wire that was buried into the bone from her previous procedure was removed. A V-shaped chevron style osteotomy was performed in a medial to lateral direction through the head of the metatarsal. It was disengaged and the metatarsal head was move medially. It was moved approximately 5 mm. It was impacted on the metatarsal shaft and held in place temporarily. This corrected a great deal of the deformity that had been present. The soft tissue correction would achieve final correction.
Therefore satisfied with the correction achieved two 2.0 x 12 mm Snap-Off bone screws were used from the dorsal to plantar direction to engage the osteotomy and fixate it in place. The bone edges were rongeured smooth. The surgical site was flushed with sterile saline. The lateral joint capsule was then tightened and plicated using 3-0 Prolene. The extensor tendon sheath was repaired using 4-0 Vicryl. A late closure on the medial joint capsule was performed and subcutaneous layers were closed with 4-0 Vicryl and the skin was closed with 4-0 Monocryl. Steri-Strips were applied to the wound and a dry sterile compressive dressing was applied to the foot.