Bone resection with interposition arthroplasty

edited May 2017 in Orthopedics
Are you suggesting to bill unspecified codeX2 and ostectomy?


  • edited May 2017
    Here is the op note:

    We carried out an incision over the lateral mid foot between the bases of the fourth and fifth metatarsals. Branches of the sural and superficial peroneal nerve are all protected. I incised the extensor muscle fascia and carefully elevated the muscle off of the joints. We exposed the joints, they are severely arthritic. As we exposed medially, we encountered an impinging screw in the lateral cuneiform. This is a titanium screw, which was removed without difficulty. I used a sagittal saw, an osteotome, and a rongeur to resect the bases of the fourth and fifth metatarsals and a little bit of the cuboid, taking care to leave the attachment of the peroneus brevis intact. I took out about 3 to 4 mm of bone so that we could see good motion from the top to the bottom of the joint. There was also an impinging osteophyte between the third and fourth metatarsals. This was removed with a rongeur. I then used an ArthroFlex graft and folded it placing the shiny end to bone. We were able to place this as an interposition graft between the third and fourth metatarsals and extend it down across the fourth and fifth tarsometatarsal joint. Excellent and stable interposition was achieved. I percutaneously fixed the fifth metatarsal to the cuboid and further secured that interposition graft using a single 2-0 titanium K-wire. This was clipped and bent. Radiographs were obtained which revealed satisfactory position. We once again irrigated the incision with sterile saline. We closed the muscle fascia with 3-0 Vicryl. We closed the subcutaneous tissue with 3-0 Vicryl and closed the skin with 4-0 nylon.

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