Operative Report Preoperative Diagnosis: Circular Saw Injury

Operative Reportpreoperative Diagnosis Circular Saw Injury With Compl

Operative Report preoperative diagnosis: Circular saw injury with complex laceration of the left index finger involving the extensor tendon, joint capsule, collateral ligament on the radial side, and a displaced fracture at the base of the middle phalanx with articular involvement. The postoperative diagnosis confirms these findings.

The procedure performed included debridement, repair of the extensor tendon and joint capsule, repair of the radial collateral ligament, and wound closure. The anesthesia used was a digital block.

The patient is a 42-year-old Caucasian male who sustained this injury while working at home. The injury involved a jagged laceration over the dorsal radial aspect at the proximal interphalangeal joint. The wound was deep, involving damage to the joint capsule, extensor tendon, collateral ligament, and the bone at the base of the middle phalanx. Sensory function was intact at the fingertip, especially on the radial side. The wound was approximately 3 cm long.

During the procedure, local anesthesia was administered with Marcaine, and the hand was prepared and draped in the usual manner. A tourniquet was applied at the base of the fingers. The wound was carefully debrided, removing loose bone fragments and damaged cartilage. The joint capsule and extensor tendon were repaired using 5-0 PDS sutures. The skin was approximated with 5-0 nylon sutures, and a dressing was applied. The tourniquet was released, and good perfusion was confirmed. An aluminum splint was placed for immobilization.

Postoperative care included administration of 1 gram of Cefazolin (Ancef) in the emergency room, with the patient instructed to continue Keftab (cephalexin) 500 mg twice daily for four days and Vicodin for pain management. The patient was advised on wound care, signs of infection, and potential stiffness of the finger. Follow-up was scheduled for ongoing assessment and care.

Paper For Above instruction

The detailed operative report for the patient with a circular saw injury to the left index finger highlights significant aspects of trauma management, injury assessment, surgical repair, and postoperative care. Accidents involving power tools such as circular saws are particularly dangerous due to the potential for complex, multi-structural damage, as exemplified in this case. The integration of accurate diagnosis, prompt surgical intervention, and meticulous postoperative management is essential for optimal recovery and limb function preservation.

The injury sustained by the patient involved a jagged laceration on the dorsal radial aspect of the index finger at the proximal interphalangeal joint. The extent of damage included not only superficial tissue disruption but also involvement of critical structures such as the extensor tendon, joint capsule, collateral ligament, and the bony base of the middle phalanx. Such complex injuries require thorough assessment, including primary debridement, repair of damaged structures, and stabilization of fractures, all aimed at restoring the anatomy and function of the finger.

Surgical intervention was performed under local anesthesia with a digital block, which effectively anesthetized the finger while allowing continuous intraoperative assessment of perfusion and nerve function. The application of a tourniquet facilitated a bloodless field, enabling detailed visualization and precise repair of damaged tissues. Prophylactic antibiotics such as Cefazolin were administered to prevent postoperative infection, especially given the contaminated nature of power saw injuries.

The debridement process involved the removal of devitalized tissue, loose bone fragments, and damaged cartilage to prevent infection and facilitate proper healing. Repair of the extensor tendon with 5-0 PDS sutures was essential to restore finger extension, and fixation of the joint capsule maintained joint stability. Repair of the radial collateral ligament was crucial for lateral stability of the finger, preventing postoperative contractures and deformities. Closure of the skin was meticulously done with fine nylon sutures to ensure minimal scarring and facilitate wound healing.

Postoperative management included immobilization with an aluminum splint to maintain proper alignment and prevent further injury. Pharmacologic management involved pain relief with Vicodin and continuation of antibiotics. The patient was also educated on wound care, signs of infection, and the importance of follow-up to monitor healing and function.

Infections are a significant concern in lacerations involving joint and tendon structures, as they can lead to septic arthritis, tenosynovitis, or delayed healing. Therefore, prompt surgical repair combined with appropriate antibiotics is critical in such cases. Furthermore, early mobilization and physical therapy may be necessary after initial healing to restore full range of motion and strength, avoiding stiffness and functional impairment.

This case exemplifies the importance of a multidisciplinary approach to hand injuries involving complex soft tissue and bony damage. The surgical team’s expertise in meticulous repair, combined with vigilant postoperative care, is essential for optimal functional recovery.

Regarding coding, the injury and procedures documented in this case involve multiple components requiring accurate billing codes. The appropriate ICD-9-CM and CPT codes are used to reflect the injury’s complexity and the interventions performed. For example, ICD-9-CM codes such as 883.0 (Open wound of finger with tissue loss) or specific fracture codes should be considered. CPT codes for debridement, tendon repair, ligament repair, and wound closure will accurately capture the procedural complexity. Ensuring proper coding supports reimbursement and statistical tracking of injury types and healthcare utilization.

References

• American Medical Association. (2021). CPT Professional Codebook. AMA Press.
• Centers for Medicare & Medicaid Services. (2022). ICD-10-CM Official Guidelines for Coding and Reporting. CMS.gov.
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