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First Metatarsal Osteotomy Operative Sample Report


Hallux abductovalgus deformity, left foot.

Hallux abductovalgus deformity, left foot.

First metatarsal osteotomy with internal fixation of the left foot.

SURGEON:  John Doe, MD


ANESTHESIA:  Local monitored anesthesia care.

HEMOSTASIS:  Left pneumatic ankle tourniquet.


MATERIALS:  One FRS Ace DePuy screw.

INJECTABLES:  10 mL of 1% lidocaine plain.

INDICATIONS FOR PROCEDURE:  The patient is a (XX)-year-old female who has presented to the office for quite sometime now with left bunion pain. The patient states that the pain has become worse and affects her normal daily activities. The patient states that pain hurts with normal daily ambulation. She has tried conservative measures, including shoe gear modification, which has failed. The patient presents for surgical correction at this time. The patient understands all risks and benefits of the procedure. No guarantees were made.

OPERATION IN DETAIL:  Under mild sedation, the patient was brought into the operating room and placed on the operating table in the supine position. A well-padded pneumatic tourniquet was then applied to the left ankle. Following IV sedation, local anesthesia was obtained with approximately 12 mL of a 1:1 mixture of 0.5% Marcaine plain and 2% lidocaine plain. The left leg was then scrubbed, prepped, and draped in the usual aseptic manner. The left leg was exsanguinated and the left pneumatic ankle tourniquet was then inflated to 250 mmHg.

Attention was then directed towards the medial aspect of the left ankle, where an approximately 4 cm longitudinal incision was made both medial and parallel to the tendon of extensor hallucis longus. The incision was then deepened through the skin and subcutaneous tissues using sharp and blunt dissection. Care was taken to identify and retract all vital neurovascular structures. All bleeders were cauterized and ligated as necessary.

Dissection was then carried down into the first metatarsal space through the same incision where a standard lateral release was performed, releasing the intermetatarsal ligament and lateral collateral ligaments. The joint was then abducted.  A lateral capsulotomy was also performed. Next, attention was then redirected towards the medial aspect of the left first metatarsal where a straight periosteal incision was made. The periosteum was then freed from the head and neck of the first metatarsal.

Next, using an oscillating bone saw, the hypertrophic medial eminence of the first metatarsal was then resected. Next, a Chevron-type osteotomy was performed on the first metatarsal head. Once the osteotomy was through and through, the capital fragments were translocated laterally into a more corrected position. Once in corrected position, capital fragment was then impacted on first metatarsal shaft and temporarily fixated with 0.045 Kirschner wire. Next, fluorescein was used to check position of capital fragments and alignment noted to be excellent at this time.

Next, using standard Ace DePuy protocol for the FRS screw, one self-tapping, self-drilling FRS screw was then driven from proximal dorsal to distal plantar perpendicular to the osteotomy. Excellent compression alignment was noted. Fluorescein was used to check position and all noted to be excellent at this time. All temporary fixations were removed and the remaining hypertrophic medial eminences were then resected. All rough edges were smoothed down as necessary.

The wound was flushed with copious amounts of normal sterile saline. Periosteum was then reapproximated and closed using 3-0 Vicryl. Subcutaneous tissue reapproximated with 4-0 Vicryl. Skin was then reapproximated and closed utilizing 4-0 nylon. Wound was then dressed with Xeroform, followed by 4 x 4s, followed by Kling, followed by Ace. The left pneumatic ankle tourniquet was deflated and a prompt hyperemic response was noted to all digits of the left foot and leg. The patient tolerated the procedure and anesthesia well. The patient was transferred to the recovery room.