Attention was then made to the left upper extremity. A closed reduction was attempted under fluoroscopy 3 times. As there was almost no movement of fracture fragments with the attempted closed reduction I did not believe an external fixator or continued attempts at closed reduction would ultimately be successful. I then created a standard longitudinal incision overlying the base of the metacarpal. The incision was cheated slightly volar to provide better access to the volar com minuted fragments. A superficial sensory branch of the radial nerve was encountered and protected throughout the case. Bovie electrocautery was utilized to provide hemostasis to the small bleeders. The EPB was encountered during the approach and protected. Careful soft tissue dissection was carried down to the CMC capsule. This was splint in line with the metacarpal. Comminuted fracture fragments were identified at this point. I carefully debrided the hematoma but attempted to leave fragments of bone in place for consolidation. Multiple comminuted fracture fragments were identified. It was noted that the fracture extended into the articular base of the metacarpal and damage was noted to the cartilage at that time. Several reduction attempt were performed utilizing 0.045 k-wires placed percutaneously. Secondary to multiple fracture fragments of varying sizes I was unable to anatomically reproduce the joint line. As such, r utilized the fragments to create a grossly aligned construct which will hopefully allow the metacarpal base to consolidate and heal. Patient will likely need additional surgical intervention in the future as he will likely develop arthritis and stiffness in this joint.
Final fluoroscopic images demonstrated bicortical fixation with k-wires as well as demonstrating residual comminution but gross alignment of the thumb metacarpal base. The pins were not bent to prevent potential loss of fixation but were cut. The pins were dressed with Xeroform and pin protectors. Fluffs were placed between the digits as well as 4x41s over the operative site. A thumb spica splint was then placed about the left upper extremity. At this point the patient was successfully awoken by the department of anesthesia and transferred to the postanesthesia care unit in stable condition.
CPT 26605? Can we code close treatment with manipulation? I'm so confused... Any tips greatly appreciate
Final fluoroscopic images demonstrated bicortical fixation with k-wires as well as demonstrating residual comminution but gross alignment of the thumb metacarpal base. The pins were not bent to prevent potential loss of fixation but were cut. The pins were dressed with Xeroform and pin protectors. Fluffs were placed between the digits as well as 4x41s over the operative site. A thumb spica splint was then placed about the left upper extremity. At this point the patient was successfully awoken by the department of anesthesia and transferred to the postanesthesia care unit in stable condition.
CPT 26605? Can we code close treatment with manipulation? I'm so confused... Any tips greatly appreciate