# question on malunion of fracture ????



## Justarose (Mar 19, 2009)

I am so new still to this and will be for a long time !!
Help please ; 

Procedures: 
1 .   Takedown of malunion w/correction
2.    Open reduction and internal fixation using two 2.0 mm titanium screws ...
3.  Volar plate release , proximal interphalangeal joint 

Would 26725 suffice ?? Cover it all ?? 

Dx :  Malunion of fracture Pl , left ring w/volar plate contracture of proximal interphalangeal joint ...

I think :  816.01   

I could be way off .. please give me some guidance 

Thanks !


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## mbort (Mar 20, 2009)

26725 is for closed reduction, this appears to be an open case.  Wanna post the note?

Also..you may want to look at 733.81 for the malunion dx 


Mary, CPC,COSC


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## Justarose (Mar 20, 2009)

*Thank you so much Mary ...here is the report*

The patient was placed on the operating table in a supine position.  After satisfactory anesthetic was established, a well-padded tourniquet was placed high on the left upper extremity, the remainder of which was prepped and draped in a sterile fashion.  A dorsal approach was fashioned with an incision on the dorsal radial aspect of P1 extending from the PIP back to the MP joint.  Dissection was deepened.  A triangular section of radial-sided intrinsic was released and excised to gain access to the fracture and minimize postoperative adhesions.  The fracture was immobile.  A rongeur was necessary to take down extensive callus formation from all sides of the fracture fragment.  A Freer elevator was placed in the fracture site.  The original cortical fracture was identified and little by little this was teased apart to allow the fracture to be reduced.  There was a nondisplaced fracture line which extended more proximally to the first with some comminution and this was stably healed and not taken apart as it was nondisplaced.  The condyles with the dorsal spike of bone was then anatomically reduced , held in position with a clamp and using a standard AO lag technique overdrilling and countersinking the near cortex.  Two 2-mm screws were used to rigidly internally fix the fracture fragments in position.  The digit was taken through a range of motion.  The PIP joint could only be brought to within 40 degrees of full extension at this point.  Dissection was then carried volarly.  The flexor tendon sheath was released from the volar and radial aspect of the proximal phalanx and flexor tendons were retracted volarly.  The volar plate at the PIP joint was then released of its proximal origin at the volar neck of proximal phalanx allowing for full extension of the PIP joint.  At this point, both clinical exam and tenodesis confirmed anatomic alignment without rotational deformity.  The wound was copiously irrigated and the skin was closed using a combination of running and interrupted horizontal mattress sutures of 5-0 Prolene stitch.  Local anesthetic was infiltrated. Xeroform, sterile bulky dressing, and an ulnar gutter splint was applied.  The procedure was concluded and the patient was taken to the recovery room in stable condition.


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## bethh05 (Mar 23, 2009)

Have you looked at 26746?


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