# Closed reduction/internal fixation



## nabernhardt (May 31, 2013)

I am really needing help with this procedure.  The patient had a proximal humerus fracture that was treated with a closed reduction and internal fixation. Here is the op note.  I did confirm with surgeon that it was a closed reduction the incision was for the internal fixation.

A standard anterolateral incision was made. Skin flaps were elevated and hemostasis was achieved with a Bovie. The deltoid was split to enter the subacromial space. A large hematoma was evacuated. We split the edge of the supraspinatus tendon vertically and inserted the entrance awl. Closed reduction was then achieved using live fluoroscopy. Once the reduction was achieved, we passed a guidewire, which allowed us to pass the VersaNail proximal humeral nail from Biomet. Once the nail had been settled into its correct position, we inserted the kickstand screw using the outrigger guide. All the screw placements were utilized using live fluoroscopy. The outrigger guide was then switched to the A and B positions to insert the alternate proximal screws and then followed by a distal screw through the nail. This originally fixed the fracture. We did not violate the articular surface. The position of the screws was check via live fluoroscopy and found to be in acceptable position. The outrigger guide was then removed.
The split in the cuff was closed with 0 Monocryl, as well as the split in the deltoid, with a
running 0 Monocryl. 0 Monocryl closed subq and staples closed the skin.


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## mitchellde (May 31, 2013)

read in the beginning section of the CPT book if you have the AMA version this was change about 7 years ago .. there is an explanation of closed vs open procedure it tells you that when an incision is made to insert an internal fixation with a closed reduction you are to code it as an open reduction procedure.


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## nabernhardt (Jun 2, 2013)

ok thank you. I was totally not aware of that. thanks again for your help appreciate it.


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