CT w/out Contrast of Lower Extremity Findings: Comminuted fracture of distal femoral diaphysis with dominant oblique component resulting in 2.8 cm medial displacement of the femoral condylar fragment. The patient is status post total left hip arthroplasty as well as total knee arthroplasty.
Procedure Performed: Open reduction internal fixation of left interprosthetic femur fracture
We began with a 3-4 cm incision on the lateral aspect of the knee overlying the
distal aspect of the femur. We went through the skin and subcutaneous tissue with a scalpel. We then switched to Bovie and went through the IT band. This was taken down to the level of the femur. We were able to visualize our fracture at this time. With a combination of traction and valgus deformity we were able to reduce the fracture in the coronal and sagittal plane. At this point we picked an appropriately sized Zimmer NCB plate and slid it in a submuscular fashion from distal to proximal. The jig was assembled to the plate prior to insertion. We then pinned the plate both proximally and distally with a K-wire. AP and lateral fluoroscopic imaging demonstrated appropriate placement of the plate. At this point, we drilled, measured and placed an appropriately-sized cortical screw in the distal aspect of the plate. This brought the plate nicely down to bone.
We then moved proximally. We inserted the trocar through the jig. Made an incision. We then drilled, measured, and placed an appropriately sized screw the proximal aspect of the plate. A locking cap was then placed over the screw. At this point fluoroscopy was brought in and demonstrated appropriate restoration of our length, alignment, rotation of our fracture. At this point, we turned to our distal cluster of screw holes in the plate. We drilled, measured and placed multiple screws. Locking caps were placed over all distal screws. We then turned proximally and placed 2 more bicortical screws as well as 2 unicortical screws around the distal aspect of hip stem. Locking caps were placed over all screws. Multiplanar fluoroscopy demonstrated once again adequate restoration of length, alignment, rotation and placement of all implants. These images were then saved. We then copiously irrigated all wounds. In the distal wound 1g of vancomycin powder was placed. The IT Band was closed with 0 Vicryl in interrupted fashion followed by 2-0 Monocryl for the subcuticular layer followed by 2-0 nylon for the skin. Proximally, the subcuticular layer was closed with 2-0 Monocryl in interruped fashion followed by 2-0 nylon for the skin. Sterile dressings were then applied.
Mechanism of Injury: Patient was getting out of bed when feet got tangled and fell to knees
Previously, when researching peri-prosthetic fractures, this is the direction I have been given:
At the direction of the “Code first” note a minimum of two codes are required when reporting periprosthetic fractures. One code is assigned from category M97 that identifies the fracture as periprosthetic and identifies the specific joint involved (ankle, knee, hip, shoulder, elbow, finger, spine, toe, wrist) including the laterality of the condition. A second code is assigned to report the specific type and cause of the fracture (traumatic vs. pathological).
Based on the instructional note, the code for the type of fracture is sequenced first followed by the periprosthetic fracture code.
Source:
https://hiacode.com/blog/education/periprosthetic-fracture-reporting-and-sequencing
