# Femur intramedullary rod replacement for congenital short femur



## jojo2922 (Oct 15, 2012)

I'm having a hard time finding the appropriate cpt for the replacement of the femur intramedullary rod.  Any assistance would be greatly appreciated.

PREOPERATIVE DIAGNOSIS
Congenital short femur __________

POSTOPERATIVE DIAGNOSIS
Congenital short femur __________

PROCEDURE
1. Removal of old rod.
2. Femoral osteotomies.
3. IM rodding, left femur.

ANESTHESIA
General.

ESTIMATED BLOOD LOSS
200 mL.

TECHNIQUE
After induction of general anesthesia, the patient was positioned on the
fracture table.  The leg was scrubbed with ChloraPrep and draped off into a
sterile field.  Under fluoroscopic control, the leg was examined and the
distal screw was localized.  __________ initially had been centered, the
center of the femur, and it was now right lateral cortex.  X-ray had shown
that the rod was actually protruding through the lateral cortex.  A 2-cm
incision was made and the screw was exposed and withdrawn without incident.
Similarly, the top screw was exposed and was withdrawn.  The top of the rod
was then exposed and the proximal plug was removed.  The extraction bolt was
then threaded into the rod and was withdrawn without incident.

After initially removing the old Synthes humeral nail, the guidewire for the
ortho pediatric femoral nail was attempted to be placed.  Due to the
corticalization around the old nail, it kept following the tract toward
exiting the lateral surface of the femur.  An attempt was made with a Synthes
hand-held reamer to broach the corticalization.  It was unsuccessful.  A 3-2
drill bit was then advanced under fluoroscopic control until it engaged into
the corticalization at the medial edge of the old rod.  We then able to
perforate that and was advanced.  This was a 3.2-mm drill bit and since the
guide rod had a 3-mm bullet tip on the end, it was felt that this could just
be passed.  It was passed and was able to advance down the canal into the
distal femur.  Reaming was then begun, initially with a 6-mm and cutting
reamer and carried up in 0.5-mm increments to 9-mm reaming.  At this time, a 7-
mm ortho pediatrics left femoral nail was selected 30 mm in length and was
placed down the canal to where it started to impact the lateral edge of the
cortex.  This was then selected as to the osteotomy site.  This corresponded
near where the initial screw had been removed.  A 3.2 drill bit was used to
perforate the cortex and this was completed with osteotomes.  With applying
abduction to the rod and valgus to the osteotomy site, the rod could be
advanced across into the distal femoral shaft.  It was then advanced down
further until it met the next band, this time more in flexion.  A similar
osteotomy was then performed at this area.  With bringing the leg out of
abduction and adduction, and extension and valgus through the osteotomy sites,
the rod was advanced in the distal femoral metaphysis.  When optimal alignment
had been obtained, the distal 2 locking screws were inserted.  An attempt was
made to further impact the rod to obtain a little distraction.  About 0.5-cm
distraction seemed to be obtained.  The proximal locking screw was then
placed.  The wounds were copiously lavaged, and deep closure was made with 2-0
and 3-0 Vicryl and skin was approximated with a 4-0 Vicryl.  The wounds were
cleaned and dressed with 4x4 and OpSite.  Anesthesia was discontinued.  The
patient was transferred back to the PACU in good condition.


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## ceesh2009 (Oct 15, 2012)

*IM Rodding*

take a look at 27245


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## jojo2922 (Oct 15, 2012)

Thanks, I had looked at 27245 but it says for fracture and since this is for lengthening due to congenital anomaly, I didn't think that was appropriate.  I have also looked at 27450 and 27454 but neither seem quite right.


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