DATE OF PROCEDURE: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Scapholunate advanced collapse degenerative arthritis, right wrist.
POSTOPERATIVE DIAGNOSIS:
Scapholunate advanced collapse degenerative arthritis, right wrist.
OPERATION PERFORMED:
1. Right wrist proximal row carpectomy.
2. Right radial styloidectomy.
3. Right posterior interosseous neurectomy.
SURGEON: John Doe, MD
ANESTHESIA: Axillary block.
COMPLICATIONS: None.
OPERATIVE FINDINGS: The patient presented with scapholunate advanced collapse degenerative arthritis of the right wrist with marked degenerative changes at the radioscaphoid joint and scapholunate dissociation. Exploration revealed that the articular surface of the lunate fossa at the distal radius and capitate head was well preserved. The scapholunate interosseous ligament was disrupted with scapholunate diastasis and rotatory subluxation of the scaphoid.
DESCRIPTION OF PROCEDURE: Prophylactic IV antibiotic was given. Axillary block anesthetic was administered by the anesthesiologist. The right upper extremity was prepped and draped sterilely. A tourniquet was inflated on the upper arm following exsanguination of the limb. A longitudinal incision was made over the dorsal aspect of the right wrist centered at the radiocarpal joint. The subcutaneous tissue was dissected. Superficial veins were ligated with bipolar cautery. Skin flaps were elevated off of the extensor retinaculum. The extensor pollicis longus tendon was retracted safely in the interval between the second and fourth, and fourth and fifth extensor compartments were developed. A T-shaped capsulotomy was made in the dorsal capsule to expose the radiocarpal and midcarpal joints. The articular surfaces were inspected. Reconstruction with proximal row carpectomy was felt to be appropriate.
The scaphoid bone was exposed by elevating the capsule sharply and scaphoid was excised in piecemeal fashion. Care was taken to preserve the important radiocarpal and extensor ligaments, which were preserved. The lunate and triquetrum bones were also exposed by elevating the capsular flaps and both bones were also excised in piecemeal fashion. The bone fragments were collected and sent to pathology as specimen. The capitate was allowed to assume its position at the lunate fossa of the distal radius. Wrist motion was checked and the flexion and extension arc was found to be satisfactory, approximately equal to the patient’s preoperative motion. Radial deviation of the wrist was limited due to the prominent radial styloid. Therefore, radial styloidectomy was needed. The styloid was exposed by elevating the capsule and the prominent portion of the styloid was excised using an osteotome. Care was taken to preserve the extrinsic ligament attachment, which was preserved. FluoroScan views were obtained to confirm adequate resection of the radial styloid. The position of capitate head at the distal radius was confirmed. Next, the terminal branch of the posterior interosseous nerve was dissected. The nerve was transected for partial denervation of the wrist.
The field was irrigated thoroughly with antibiotic solution. The capsular flaps were reapproximated and sutured with 3-0 Vicryl sutures. Skin edges were reapproximated with nylon sutures. A sterile bulky gauze dressing was applied followed by forearm-based plaster splint to maintain the wrist in neutral alignment. The tourniquet was deflated. Circulation returned to the right hand with normal capillary refill in all digits. The patient was transferred to the recovery room in stable condition. The patient tolerated the procedure well. There were no complications.
