DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Right thumb carpometacarpal joint arthritis.
POSTOPERATIVE DIAGNOSIS:
Right thumb carpometacarpal joint arthritis.
OPERATION PERFORMED:
Right thumb carpometacarpal joint arthroplasty with palmaris longus tendon graft.
ANESTHESIA: General.
TOURNIQUET TIME: 105 minutes.
SPECIMENS: None.
BLOOD LOSS: Minimal.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old male who was complaining of pain at the base of the right thumb for many years. He had failed nonoperative splinting, corticosteroid injection. X-rays demonstrated stage III CMC arthritis. The patient now presents for right thumb CMC arthroplasty. Risks and benefits of the surgery including infection, bleeding, recurrence, persistent pain, and weakness were explained. He understood the risks and benefits and wished to proceed.
DESCRIPTION OF OPERATION: The patient was taken to the operating room and placed on the table in the supine position. General anesthesia was induced. The right upper extremity was prepped and draped in sterile fashion. The limb was exsanguinated, and tourniquet was inflated to 250 mmHg.
A curvilinear incision was then made at the base of the thumb metacarpal on the radial border. This incision was carried through the skin and subcutaneous tissue. The insertion of the abductor pollicis longus was then partially elevated off the metacarpal exposing the capsule. The capsule was incised longitudinally. Trapezium was identified, and the borders of the trapezium were verified using FluoroScan imaging.
At this point, the trapezium was sectioned with an osteotome and excised in piecemeal fashion. The wound was copiously irrigated removing all bone fragments. At this point, irregular surfaces were then smoothed down with bur, and once this was done, it was found that the beak ligament was intact and stable and holding the metacarpal adequately suspended.
Therefore, at this point, a second incision was then made at the wrist crease along the palmaris longus tendon. This incision was carried through skin and subcutaneous tissue. The palmaris longus tendon was then elevated using dissection scissors and transected distally. A second counterincision was then made at the muscular tendon junction of the palmaris longus. The palmaris longus was brought out through the second incision more proximally and transected off the muscle belly. Any remaining muscle fibers were excised off the tendon. The tendon was then folded upon itself, placed into the wound and sutured with 3-0 chromic single interrupted sutures.
At this point, the wounds were copiously irrigated with normal saline. Capsule was closed with 4-0 FiberWire single interrupted sutures. A K-wire was placed through the thumb metacarpal into the second metacarpal, suspending it. Proper placement was verified under FluoroScan. The incisions were closed with 4-0 Vicryl single interrupted sutures and 5-0 nylon, combination of single interrupted sutures, and subcuticular suture. Bulky sterile dressing and splint was applied. The patient tolerated the procedure well and was taken to the recovery room in stable condition.
