Preoperative Patient Care A Outpatient Evaluation and Management 1 Obtain focused history and performs focused exam concomitant and associated orthopaedic injuries differential diagnosis and physical exam tests 2 Prescribes and manages nonoperative treatment orders appropriate orthosis 3 Makes informed decision to proceed with operative treatment documents failure of nonoperative management describes accepted indications and contraindications for surgical intervention 4 Provides postoperative management and rehabilitation 2 week postoperative visit remove sutures check for consolidation on radiographs diagnose and management of early complications B Advanced Evaluation and Management 1 Provides post-op management and rehabilitation C Preoperative H & P 1 Perform basic medical and orthopaedic history and physical check neurovascular status check range of motion 2 Perform operative consent describe complications of surgery including malunion delayed union or nonunion pin site or surgical wound infection extensor tendon adhesions or ruptures MCP or interphalangeal capsular contractures Operative Techniques E Preoperative Plan 1 Execute surgical walkthrough describe the steps of the procedure verbally prior to the start of the case 2 Description of potential complications and steps to avoid them F Room Preparation 1 Surgical Instrumentation headless screws guidewires 2 Room setup and Equipment standard operating table hand table 3 Patient Positioning patient placed in the supine position with hand on hand table place tourniquet high on the affected extremity G Incision 1 Mark and make the incision make a longitudinal or curvilinear incision over the metacarpal head 2 Bluntly dissect to the extensor mechanism H Soft Tissue Dissection 1 Expose the fracture site split the extensor mechanism longitudinally incise the capsule I Fracture Reduction 1 Manipulate the MCP joint flex the MCP joint this will facilitate the exposure of the fracture 2 Reduce the fracture use a dental pick or small pointed reduction forceps to reduce the fracture J Provisional Fixation 1 Place guidewires insert guidewires from a cannulated headless screw set K Definitive Fixation 1 Place headless screws insert headless screws over the guidewires 2 Confirm placement and reduction check the screw placement and fracture reduction radiographically L Wound Closure 1 Close the periosteum and soft tissues close the periosteum and the interosseous muscle fascia over the plate this provides a smooth gliding surface for the extensor mechanism 2 Repair the extensor mechanism close the extensor mechanism with 4-0 nonabsorbable suture 3 Superficial closure close the skin with 3-0 monocryl suture N Wound Closure Postoperative Patient Care O Perioperative Inpatient Management 1 Write comprehensive postoperative orders 2 Orders appropriate inpatient occupational and physical therapy 3 Discharges patient appropriately write for pain meds schedule follow up appointment in 2 weeks R Complex Patient Care 1 Comprehensive pre-op planning/alternatives. 2 Modify and adjust post-op plan as needed
A Outpatient Evaluation and Management 1 Obtain focused history and performs focused exam concomitant and associated orthopaedic injuries differential diagnosis and physical exam tests 2 Prescribes and manages nonoperative treatment orders appropriate orthosis 3 Makes informed decision to proceed with operative treatment documents failure of nonoperative management describes accepted indications and contraindications for surgical intervention 4 Provides postoperative management and rehabilitation 2 week postoperative visit remove sutures check for consolidation on radiographs diagnose and management of early complications B Advanced Evaluation and Management 1 Provides post-op management and rehabilitation C Preoperative H & P 1 Perform basic medical and orthopaedic history and physical check neurovascular status check range of motion 2 Perform operative consent describe complications of surgery including malunion delayed union or nonunion pin site or surgical wound infection extensor tendon adhesions or ruptures MCP or interphalangeal capsular contractures
E Preoperative Plan 1 Execute surgical walkthrough describe the steps of the procedure verbally prior to the start of the case 2 Description of potential complications and steps to avoid them F Room Preparation 1 Surgical Instrumentation headless screws guidewires 2 Room setup and Equipment standard operating table hand table 3 Patient Positioning patient placed in the supine position with hand on hand table place tourniquet high on the affected extremity G Incision 1 Mark and make the incision make a longitudinal or curvilinear incision over the metacarpal head 2 Bluntly dissect to the extensor mechanism H Soft Tissue Dissection 1 Expose the fracture site split the extensor mechanism longitudinally incise the capsule I Fracture Reduction 1 Manipulate the MCP joint flex the MCP joint this will facilitate the exposure of the fracture 2 Reduce the fracture use a dental pick or small pointed reduction forceps to reduce the fracture J Provisional Fixation 1 Place guidewires insert guidewires from a cannulated headless screw set K Definitive Fixation 1 Place headless screws insert headless screws over the guidewires 2 Confirm placement and reduction check the screw placement and fracture reduction radiographically L Wound Closure 1 Close the periosteum and soft tissues close the periosteum and the interosseous muscle fascia over the plate this provides a smooth gliding surface for the extensor mechanism 2 Repair the extensor mechanism close the extensor mechanism with 4-0 nonabsorbable suture 3 Superficial closure close the skin with 3-0 monocryl suture N Wound Closure
O Perioperative Inpatient Management 1 Write comprehensive postoperative orders 2 Orders appropriate inpatient occupational and physical therapy 3 Discharges patient appropriately write for pain meds schedule follow up appointment in 2 weeks R Complex Patient Care 1 Comprehensive pre-op planning/alternatives. 2 Modify and adjust post-op plan as needed