# Need help on this Trimalleolar fracture



## Amzie (Dec 22, 2011)

Dr diagnosed patient with a trimalleolar ankle fracture.. In reading this op report, I am only seeing an ORIF of a Bimalleolar ankle fracture.. Need another opinnion please!!

Procedure performed: ORIF right ankle
Description of findings: 
communited fibula fracture
anatomic reduction performed of both the fibula and medial malleolus
plate and screws were placed on the fibula and two unicortical screws at the medial malleolus.

Procedure:
Surgery commenced with lateral approach to the distal fibula. The superficial peroneal nerve was identified designating approximately 4 cm proximal to the tip of the fibula. The nerve was carefully identified and protected throughout the entire procedure. Next, periosteal elevator was used to expose the fracture site. Curettes were used to lightly debride the fracture site exposing the bony ends. The wound was throughly irrigated. A 6 hole plate was selected. Reduction was performed using lobster claw. A lag screw was initally inserted but did not have stable fixation and therefore lboster claw was used for the reduction. The plate was then placed and using the AO technique, distal unicortical screw was first inserted. Placement of plate and screw was confirmed as satisfactory via C arm imaging. The rest of the screws were then inserted. Cancellous screws were used distally and cortical screws proximally. Proximal screws were bicortical. The wound was then thoroughly irrigated and attention was focused to the medial malleolus. Standard approach to the medial malleolus was undertaken and periosteal elevator was used after dissection with tenotomy scissors. the fracture site was exposed and towel clamp was used for reduction. A 2-0 K wire was placed anteriorly using the C arm imaging for guidance so that the pin was not within the joint. next, using standard AO technique, a 3.5 x 50mm cortical screw was inserted parallel and posterior to the initial K wire. Next the K wire was removed and another 3.5 x 15mm cortical screw was placed. Again, C arm imaging confirmed satisfactory redcution and placement of hardware. 

Any takers or suggestions on this?


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## Amzie (Dec 27, 2011)

Any suggestions anyone??


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## maryanneheath (Dec 28, 2011)

My opinion is that you can still use the open tx of the trimalleolar fracture (27822-27823) as the description states "medial and / or lateral malleolus, without fixation of posterior lip" or "with fixation of posterior lip".....to me the CPT description does not read that all three areas have to be treated, or that even two areas have to be treated.  The doctor is still treating a diagnosed trimalleolar fracture.  Make sense?  I could be all wet, this is just the way I see it.


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