op note buion hammertoe procedure

8/11/2019 Op Note Buion HammerToe Procedure

1/3

PREOPERATIVE DIAGNOSIS: Hallux abductovalgus deformt! a"d ### $ammertoe% ### foot&

POSTOPERATIVE DIAGNOSIS: Hallux abductovalgus deformt! a"d ### $ammertoe% ###

foot&

PRO'ED(RE: )odfed Aust" bu"o"ectom! *t$ scre* fxato" a"d ### $ammertoe re+ar%### foot&

S(RGEON,S-: ###

ASSISTANT: ###

ANESTHESIA: .ocal *t$ mo"tored a"est$esa care&

PATHO.OG/: No"e&

)I'RO0IO.OG/: No"e&

HE)OSTASIS: P"eumatc a"1le tour"2uet a"d 0ove&

ESTI)ATED 0.OOD .OSS: )"mal&

IN3E'TA0.ES: No"e&

)ATERIA.S: ###4&5 +artall! t$readed ca""ulated scre*

DRESSING: Sta"dard&

'O)P.I'ATIONS: No"e&

PRO'ED(RE IN DETAI.: T$e +ate"t receved ### +reo+eratvel! a"d u"der mld sedato" *as

broug$t to t$e o+erat"g room a"d +laced su+"e o" t$e o+erat"g table& A surgcal tme6out *as

ta1e" " *$c$ t$e +ate"t% t$e surgcal ste a"d t$e +rocedure *ere verfed& A +"eumatc a"1le

tour"2uet *as +laced over +added 7ebrl arou"d t$e ### a"1le& 8ollo*"g "trave"ous sedato"

local a"est$etc *as "fltrated arou"d t$e +ate"t9s frst a"d ### metatarsals us"g ### m. of :

mxture of ;< ldoca"e +la" a"d 5&=< )arca"e +la"& T$e ###foot a"d a"1le *ere t$e"

scrubbed% +re++ed a"d dra+ed " t$e usual ase+tc ma""er& A" Esmarc$ ba"dage *as utl>ed a"d

t$e ###lo*er extremt! *as exsa"gu"ated a"d t$e tour"2uet *as "flated&

Atte"to" *as drected to t$e dorsal as+ect of t$e ###;"d PIP3 *$ere lo"gtd"al s1" "cso"*as made& T$e s1" "cso" *as dee+e"ed to t$e level of t$e PIP3 ca+sule *$ere a tra"sverse

ca+sulotom! *as +erformed& T$e medal a"d lateral collaterals *ere released a"d t$e $ead of t$e

+roxmal +$ala"x as *ell as t$e base of t$e "termedate +$ala"x *ere ex+osed& (s"g a"

osslat"g sa*% t$e $ead of t$e +roxmal +$ala"x a"d t$e base of t$e "termedate +$ala"x *ere

resected *t$ +arallel cuts& T$e resected surfaces *ere rea++roxmated a"d fxated *t$ a ?6*re&


2/3

###Next% *e released t$e 8D0 a"d 8D. te"do"s at t$e level of t$e )TP3 as *ell as +erfom"g a

medal release of t$ ;"d )TP3&

T$e toe *as "oted to be alg"ed *ell " all +la"es&

Atte"to" *as drected to t$e dorsomedal as+ect of t$e rg$t foot *$ere a lo"gtud"al s1""cso" *as made medal to t$e exte"sor $allucs lo"gus te"do"& T$e s1" "cso" *as t$e"

carred do*" to t$e level of t$e ca+sule avod"g a"! "eurovascular structures& O"ce t$e ca+sule

*as vsual>ed t *as lo"gtud"all! "csed a"d reflected bot$ laterall! a"d medall! ex+os"g t$e

medal em"e"ce&

At t$s tme us"g a" oscllat"g sa* t$e medal em"e"ce *as resected& Next our atte"to" *as

drected to t$e dorsal as+ect of t$e frst "termetatarsal s+ace *$ere us"g s$ar+ a"d blu"t

dssecto" t$e +la"tar lateral structures of t$e frst metatarso+$ala"geal @o"t *ere vsual>ed& Att$s tme us"g a = blade a lateral release *as +erformed *$c$ *as made t$e $allux

abductovalgus deformt! easl! reducble&

Our atte"to" *as redrected to t$e medal as+ect of t$e frst metatarsal *$ere us"g a" oscllat"gsa* a modfed c$evro" cut *as +erformed *t$ t$e lo"g dorsal arm& O"ce t$e osteotom! *as

+erformed t$e dstal ca+tal fragme"t *as tra"s+osto"ed laterall! u"tl t$e desred alg"me"t of

t$e $allux *as obta"ed& I" t$s +osto" t$e dstal fragme"t *as m+acted a"d a gude*re *as

+laced across t$e osteotom! ste " a dstal dorsal to +roxmal +la"tar ore"tato"&

O"ce t$e gude*re *as " +lace *e drlled over t$e gude*re a"d +laced a ### scre* across t$e

osteotom! ste& O"ce t$e scre* *as " +lace t *as "oted to +rovde good com+resso" across t$e

osteotom! ste a"d t$e dstal ca+tal fragme"t *as stable *t$ $allux " t$e desred alg"me"t&

Next% us"g a" oscllat"g sa* t$e medal over$a"g *as resected a"d t$e dorsal medal as+ect of

t$e frst metatarsal *as rou"ded off to avod a"! +rom"e"t edges& T$e *ou"d *as rrgated *t$co+ous amou"ts of "ormal sal"e a"d closed " a la!er6b!6la!er fas$o" us"g a ru"""g

subcutcular suture tec$"2ue for s1" closure&

T$e "cso" *as t$e" dressed *t$ Ster6str+s% 0etad"e soa1ed Ada+tc% gau>e fluffs% ?l"g a"d

'oba" *t$ t$e Hallux s+l"ted " t$e corrected +osto"& T$e tour"2uet *as deflated a"d a

+rom+t $!+eremc res+o"se *as "oted to all dgts of t$e ### foot&

T$e +ate"t tolerated t$e +rocedure a"d a"est$esa *ell& ### *as tra"sferred to t$e recover! room

*t$ vtal sg"s stable a"d vascular status "tact to t$e ### lo*er extremt!&

8ollo*"g a +erod of +osto+eratve mo"tor"g s$e *ll be dsc$arged $ome *t$ t$e follo*"g

+osto+eratve "structo"s:

& ?ee+ ###foot elevated *$e" at rest&

;& Avod excessve ambulato" over t$e "ext several da!s&

4& (se surgcal s$oe for all *eg$tbear"g actvtes&


3/3

B& Retur" to cl"c for +osto+eratve follo*u+ *t$ Dr& ###&

=& 'all cl"c f a"! +roblems arse&

op note buion hammertoe procedure

Documents