Can someone look over the operative report below and let me know what you think? My thoughts are:

F1-20680 V54.01, 996.40

F2-20680 V54.01, 996.40

F1-26471 not sure about diagnosis code, maybe 709.2

F2-26471 not sure about diagnosis code, maybe 709.2

L8699 ????

Report also mentions implant of kwire. I show manipulation is bundled. I appreciate any info.

Thanks,
Vickie

PREOPERATIVE DIAGNOSES:

Healed fractures of the proximal phalanx left index and middle fingers with severe stiffness of both PIP joints.
Adherent cyst between the extensor tendon and hardware.

POSTOPERATIVE DIAGNOSES:

Healed fractures of the proximal phalanx left index and middle fingers with severe stiffness of both PIP joints.
Adherent cyst between the extensor tendon and hardware.

PROCEDURE: Hardware removal of plate and screws from the proximal phalanx of left index and middle fingers.
Extensive tenolysis of the extensor mechanism of the proximal phalanx.
Manipulation of the PIP joint and pinning in flexion with K-wires and application of splint.

ANESTHESIA: General

OPERATIVE PROCEDURE: With the patient under general anesthesia, prepping and draping of his left upper extremity was done. The tourniquet was inflated to 200 mmHg.

I first repeated the same incision he had one year ago for the ORIF of his hand after a work injury in 2009. He had internal fixation on December 23, 2009. I removed the previous nylon stitches on the extensor tendon. I split the extensor tendon longitudinally at the same place. I then realized that the extensor tendon was stuck to the plate and there was a lot of scar tissue present. I freed up the scar tissue meticulously under loupe magnification. After freeing the scar tissue from the plate, I removed the plate with the screwdriver. I removed six screws and a plate on both proximal phalanxes of the middle and index fingers.

I freed both extensor mechanisms from the MCP joint to the PIP joint. After the extensor mechanism was freed, I could bend the PIP joint to 90 degrees. Before surgery, the patient had absolutely no motion of his PIP joint. I then pinned both PIP joints in flexion at 90 degrees with two K-wires coming from the top of the distal proximal phalanx and going in line with the middle phalanx to hold the finger in flexion for the first five days.

The extensor mechanism was closed with 5-0 nylon sutures and the skin was closed with 4-0 Prolene sutures. A cover was put on both pins. I used local anesthesia for pain management postoperatively. I placed the hand in a dorsal Orthoglass splint with the wrist in extension and the fingers in flexion. The tourniquet was taken down with good capillary refill. The patient tolerated the procedure well. He was transferred to the recovery room in stable condition.




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