# ORIF nonunion tibial shaft fx with allograft?



## kibbit99 (May 8, 2009)

Since no graft was obtained from patient, but allograft of bone chips was used, would this be the CPT? Thanks go all in advance!


OP: 
We first approached the fractured area through an anterolateral incision.  This was taken down to the tibial crest and the periosteum was stripped proximally and distally.  The large spike was mobile but we could not get it down into the bed from where it had come, so it took a lot of local debridement with curettes, osteotomes, rongeur to improved mobility.  Even at that, there was a little bit of shortening of the tibial shaft, so the only way we could really get this piece down was to nibble off perhaps 3/8 inch of the distal end of the spike which then enabled us to get this reduced satisfactorily.  We went back and cleaned up the nonunion, both on medial side and the lateral side, going up as far proximally as we could into the tibial shaft.  

Once we were able to get this down, I felt comfortable we would be able to get a good fixation using the Zimmer plate.

The Zimmer NCCB (non contact bridging) plate was used.  We selected a 9-hole plate which I felt gave us adequate length. This was inserted through the incision made over the proximal end of the spaced to apply the top of the plate to the lateral edge of the tibia just below the joint surface.  We were able to create a path using Cobb elevators.  Then we were able to see the plate as it came down the lateral joint surface.

The place secured with small Steinmann pins, both proximally and medially, until we were satisfied with the placement of the plate. We then used clamps to reduce fracture surface.  Before we proceeded, we then used a 30 ML bottle of allograft bone fracture itself.  Approximately 1/3 of total volume was inserted into this fracture itself of the rest was saved to to around the fracture.  We then secured the plate, first proximally with several of the long 5mm NCB cancellous screws.  Then, shaft of the tibia.  Once this was done, we then began inserting the locking screws, then we began inserting more of these NCB screws.  The 40 mm cortical screws were filling all nine holes.  After these screws were inserted, we began inserting locking caps.  Nine locking caps were added and I felt that we had very rigid fixation.  

The remainder of the bone graft was inserted medially along in fracture surfaces, also laterally.  Some were inserted more proximally where there was still some incomplete healing in the metaphyseal area.

Routine skin closure was then carried out.  A big bulky dressing was applied.  A new knee immobilizer was then applied to maintain some pressure and the patient was then awakened and returned to the recovery room.


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## mbort (May 8, 2009)

are you looking at 27790?

mary, CPC, COSC


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## kibbit99 (May 8, 2009)

27790? Do you mean 27720?  That was the code I was looking at.


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## mbort (May 8, 2009)

yes thank you 27720 that was a typo not 27790


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## kibbit99 (May 8, 2009)

Great, thank you!


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