debellis59
Networker
I'm having some trouble with this surgery and would love some insight from some of you more experienced orthopedic coders. I was thinking Arthrodesis of the ankle, but I really don't think that is correct. Any help would be appreciated. Another coder and I thought it would be arthrodesis ... she (doc) says it was open fixation only of the tibiotalocalcaneal joint. I'm thinking then maybe CPT 27827?
The patient was brought to the operating room and transferred to the OR table and given general anesthesia without complications. 2gm of Ancef was given for antibiotic prophylaxis. The affected extremity was prepped and draped in a standard fashion. A SCD was placed on the unaffected leg and activated. A surgical pause was held to properly identify the patient, note that the surgical site was marked, and to verify that the planned procedure was clearly indicated on the consent form.
I reduced the tibiotalar joint and provisionally held the reduction as well as. A small incision was made directly over the plantar foot with confirmation of center center positioning on imaging followed by ball tip guidewire. Prior to any reaming I first checked a harris axial view to ensure I liked the position of my nail as well as AP and L ankle. An opening reamer was used followed by sequential reaming to 11.5mm. After this the nail was inserted the subtalar followed be lateral to medial screw was used with excellent purchase in both screws. Though the sustantaculum screw may be just longer of bicortical I kept this given 1) the purchase and 2) given no joint prep I felt I needed as much distal fixation strength as possible and would have used the remaining calcaneal cuboid screw however based on my nail trajectory this would not be possible.
Next attention was turned to proximal interlocking screws both of which had excellent purchase. Final fluroscopic images confirmed excellent alignment of the tibiotalar joint, screw placement and nail prominence was not present plantar.
All incisions were irrigated. Closure of was done in layered fashion with 3.0 monocryl and 3.0 nylon.
xeroform was applied to the fracture blister site that was debrided on the medial skin as it had opened and the remaining blisters were left. Soft sterile dressing was applied to the incisions followed by a cam walker boot as I want to be able to assess his skin this week prior to DC to a facility and prior to dc will plan to transition to a cast. The patient tolerated the procedure well, emerged from anesthesia without difficulty, and arrived in the PACU in stable condition.
The patient was brought to the operating room and transferred to the OR table and given general anesthesia without complications. 2gm of Ancef was given for antibiotic prophylaxis. The affected extremity was prepped and draped in a standard fashion. A SCD was placed on the unaffected leg and activated. A surgical pause was held to properly identify the patient, note that the surgical site was marked, and to verify that the planned procedure was clearly indicated on the consent form.
I reduced the tibiotalar joint and provisionally held the reduction as well as. A small incision was made directly over the plantar foot with confirmation of center center positioning on imaging followed by ball tip guidewire. Prior to any reaming I first checked a harris axial view to ensure I liked the position of my nail as well as AP and L ankle. An opening reamer was used followed by sequential reaming to 11.5mm. After this the nail was inserted the subtalar followed be lateral to medial screw was used with excellent purchase in both screws. Though the sustantaculum screw may be just longer of bicortical I kept this given 1) the purchase and 2) given no joint prep I felt I needed as much distal fixation strength as possible and would have used the remaining calcaneal cuboid screw however based on my nail trajectory this would not be possible.
Next attention was turned to proximal interlocking screws both of which had excellent purchase. Final fluroscopic images confirmed excellent alignment of the tibiotalar joint, screw placement and nail prominence was not present plantar.
All incisions were irrigated. Closure of was done in layered fashion with 3.0 monocryl and 3.0 nylon.
xeroform was applied to the fracture blister site that was debrided on the medial skin as it had opened and the remaining blisters were left. Soft sterile dressing was applied to the incisions followed by a cam walker boot as I want to be able to assess his skin this week prior to DC to a facility and prior to dc will plan to transition to a cast. The patient tolerated the procedure well, emerged from anesthesia without difficulty, and arrived in the PACU in stable condition.
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