# ORIF of the left posterior distal tibia, and the left distal fibular shaft



## bonnies1103 (Jan 16, 2017)

*Can someone help me with the CPT codes for this surgery?*

Preoperative Diagnosis: FX distal left ankle with displaced FX distal third of fibula shaft and large displaced posterior malleolar FX
Postoperative Diagnosis: Same

Description of Procedure (scrubbed): A longitudinal incision was made over the distal fibula extending from 2-3 cm above the fracture down nearly to the ankle joint. This was carried to subcutaneous tissue with careful dissection down to the lateral fibular shaft. The fracture was exposed proximally, and more distally the posterior tissue was elevated for a posterior lateral approach to the distal tibia. A large bony tenaculum was used in the posterior tibia to pull the segment down, and help reduce the fracture. This was inserted in to a soft spot in the anterolateral distal tibia. The fracture was gently manipulated, and checked with the C-arm, and a fairly nice reduction was obtained. Using the Synthes 4.0 cannulated screws, a guidepin was passed from posterolateral to anteromedial across the fracture. An additional more distal pin was the inserted. A 4.0 cannulated screw was also introduced superior to these. Attention was then turned to the fibular shaft fracture. This was held reduced with a clamp while a 7-hole third tubular plate was applied to the lateral fibula, with 3 screws proximal and 3 screws distal to the fracture. This appeared to hold the fracture in very good position, without any obvious problems. This was checked with the C-arm, and the fibular fracture appeared in excellent position, and fairly well fixed. The posterior malleolar fracture was also very nicely reduced.

I have looked at 27766, 27814, 27758, and 27792. Any help that I could get with this would be greatly appreciated.


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