Tanesha Butler
Member
I came up with fusion code for this, but the spur was excised first from the tarsometarsal joint. I followed through in 3M but it's given me a tumor exc. code which I don't want. Since the spur was removed and it was followed with a fusion of the same area, I'm thinking that I just go with the fusion, but not sure. Does any one have any experience with this?
POSTOPERATIVE DIAGNOSIS: Right foot first tarsometatarsal bone spur.
PROCEDURES:
1. Excision of right first tarsometatarsal bone spur.
2. Fusion of right first tarsometatarsal joint. 28740-RT
IMPLANTS USED: Acumed mid foot locking plate.
INDICATIONS FOR PROCEDURE: This is a 16-year-old female with quite
significant foot pain that has been going on for quite sometime. She had
imaging studies which showed a bone spur over the first tarsometatarsal
joint that was quite prominent and painful. I had a discussion with the
patient and her mom about the options and talked about going to the
operating room for taking this bone spur out. The concerns were that she
may have arthritis in the joint but also that when the spur is removed that
may destabilize the joint and we may have to fuse it in order to provide
stability in a Lapidus type procedure. The patient and the mom wished to
proceed as this has been bothering her for quite sometime. We talked about
the risks including risk of bleeding, infection, damage to nerves,
ligaments, tendons, blood vessels or other structures, nonunion, malunion,
need for further procedures, as well as incomplete or no resolution or even
worsening of symptoms. Benefits included hopefully resolution of her
symptoms and allowing her to have a pain free foot. Informed consent was
obtained.
DESCRIPTION OF PROCEDURE: The patient was identified in the preop area.
She was then taken to the operating room where a timeout was performed to
reconfirm her identity and surgical site. She was put to sleep with
general anesthesia and the right lower extremity was placed in a tourniquet
at thigh and then was prepped and draped per sterile surgical fashion.
The extremity was elevated and the tourniquet was inflated to 250
millimeters of mercury. An incision was made over the first/second
tarsometatarsal joint space and dissection was carried down to the EHL
tendon, which was retracted out of the way. The first tarsometatarsal
joint was then identified and the bone spur was identified at the joint.
This was excised utilizing a rongeur to flatten out the surface. Once this
was done, we noted that the joint was in good shape; however, there was
some concern of instability of the joint. At this point, we therefore
decided to proceed with the fusion of the joint and this was done by taking
down the cartilage with osteotomes and a bur and then irrigating the wound
and then compressing across the first tarsometatarsal joint with the
pointed reduction clamps and then placement of a fifth plate over the
joint. It was fixed proximally and distally with multiple screws to
stabilize the joint. Once the plate was in position as verified on
fluoroscopy to be in good position, the clamps were removed and the
reduction as well as the position of the hardware was found to be
satisfactory. The wound was then thoroughly irrigated and the tourniquet
was let down. It was noted that there was also a little bump over the base
of the second metatarsal, so this was just shaved down a little bit with a
bur without exposing that joint. The wound was then thoroughly irrigated
and closed in layers using 2-0 Vicryl and 3-0 nylon suture. The patient
was then placed in a well padded short leg splint.
POSTOPERATIVE DIAGNOSIS: Right foot first tarsometatarsal bone spur.
PROCEDURES:
1. Excision of right first tarsometatarsal bone spur.
2. Fusion of right first tarsometatarsal joint. 28740-RT
IMPLANTS USED: Acumed mid foot locking plate.
INDICATIONS FOR PROCEDURE: This is a 16-year-old female with quite
significant foot pain that has been going on for quite sometime. She had
imaging studies which showed a bone spur over the first tarsometatarsal
joint that was quite prominent and painful. I had a discussion with the
patient and her mom about the options and talked about going to the
operating room for taking this bone spur out. The concerns were that she
may have arthritis in the joint but also that when the spur is removed that
may destabilize the joint and we may have to fuse it in order to provide
stability in a Lapidus type procedure. The patient and the mom wished to
proceed as this has been bothering her for quite sometime. We talked about
the risks including risk of bleeding, infection, damage to nerves,
ligaments, tendons, blood vessels or other structures, nonunion, malunion,
need for further procedures, as well as incomplete or no resolution or even
worsening of symptoms. Benefits included hopefully resolution of her
symptoms and allowing her to have a pain free foot. Informed consent was
obtained.
DESCRIPTION OF PROCEDURE: The patient was identified in the preop area.
She was then taken to the operating room where a timeout was performed to
reconfirm her identity and surgical site. She was put to sleep with
general anesthesia and the right lower extremity was placed in a tourniquet
at thigh and then was prepped and draped per sterile surgical fashion.
The extremity was elevated and the tourniquet was inflated to 250
millimeters of mercury. An incision was made over the first/second
tarsometatarsal joint space and dissection was carried down to the EHL
tendon, which was retracted out of the way. The first tarsometatarsal
joint was then identified and the bone spur was identified at the joint.
This was excised utilizing a rongeur to flatten out the surface. Once this
was done, we noted that the joint was in good shape; however, there was
some concern of instability of the joint. At this point, we therefore
decided to proceed with the fusion of the joint and this was done by taking
down the cartilage with osteotomes and a bur and then irrigating the wound
and then compressing across the first tarsometatarsal joint with the
pointed reduction clamps and then placement of a fifth plate over the
joint. It was fixed proximally and distally with multiple screws to
stabilize the joint. Once the plate was in position as verified on
fluoroscopy to be in good position, the clamps were removed and the
reduction as well as the position of the hardware was found to be
satisfactory. The wound was then thoroughly irrigated and the tourniquet
was let down. It was noted that there was also a little bump over the base
of the second metatarsal, so this was just shaved down a little bit with a
bur without exposing that joint. The wound was then thoroughly irrigated
and closed in layers using 2-0 Vicryl and 3-0 nylon suture. The patient
was then placed in a well padded short leg splint.