Sara82
Guru
Can I bill for both the ORIF and the Revision? Or would the ORIF be included with the Revision? Op Report below. Thanks in advance for your help.
Supracondylar periprosthetic left femur fracture.
OPERATION PERFORMED:
1. Left supracondylar femur fracture open reduction and internal
fixation.
2. Revision total knee replacement.
Sharp
dissection was carried out down to the level of the fascia. The
extensor mechanism was opened through a standard medial
parapatellar approach and extended a bit proximally as well.
This took us into the knee joint where there was a large
hemarthrosis. This was evacuated. There was severe comminution
of the fracture. The femoral component was more or less impacted
into the femur, and the femur was split into a lot of pieces.
Her bone was extremely osteoporotic and pliable. We
painstakingly exposed distal end of the femur subperiosteally.
We worked our way around the medial and lateral sides, releasing
the collateral ligaments. We worked through the notch and
released the posterior cruciate ligament. Careful attention was
paid to stay on the bone at all times. We worked our way around
the femur and ultimately shelled out in 2 separate pieces the
distal femur with the femoral component on it. It should be
mentioned that prior to doing this, we reduced the fracture and
marked our alignment. We marked our resection for 60 mm, and we
also marked the trochlea on the remaining proximal portion of the
femur so that we could assess rotation adequately. With this
piece removed, we turned our attention to the tibia. The tibia
was exposed medially and laterally around the bone. Oscillating
saw was utilized to free up the cement bone interface, and the
tibial component was removed without difficulty. We removed all
the cement. We set about preparing the tibia. We sized it to a
2.5. We broached for the 45 mm sleeve. We had good stability
with this and impacted it into place. We then reamed the femoral
canal and broached this up with a 34 sleeve. This brought us
right at the cut edge of the femur after making a fresh, new cut.
We then went back and forth with various polyethylenes and
various femoral sizes and adapters until we had good position and
were happy that we had good tracking of the femur. Rotation was
marked and set based on the patellofemoral joint. We were happy
that we had overall good length. The final components were made.
The tibial component was cemented into place. We passed a
cerclage wire cable around the distal portion of the femur to
relieve the hoop stresses. The final component was assembled on
the back table and then impacted into place. It was quite tight
and had quite nice fit of the sleeve in the distal femur. We
went back and forth and tried a couple of different polyethylenes
and settled on a 12 mm polyethylene. This gave us good full
extension and appropriate tension on the soft tissues and the
extensor mechanism. The knee would flex to about 100 degrees
with nice patellar tracking. Happy with this, the wound was
copiously irrigated with antibiotic solution. A single drain was
placed. The soft tissue in the periosteum was closed over the
components up to the suprapatellar pouch. The extensor mechanism
was closed with 0 Vicryl suture in appropriate fashion.
Supracondylar periprosthetic left femur fracture.
OPERATION PERFORMED:
1. Left supracondylar femur fracture open reduction and internal
fixation.
2. Revision total knee replacement.
Sharp
dissection was carried out down to the level of the fascia. The
extensor mechanism was opened through a standard medial
parapatellar approach and extended a bit proximally as well.
This took us into the knee joint where there was a large
hemarthrosis. This was evacuated. There was severe comminution
of the fracture. The femoral component was more or less impacted
into the femur, and the femur was split into a lot of pieces.
Her bone was extremely osteoporotic and pliable. We
painstakingly exposed distal end of the femur subperiosteally.
We worked our way around the medial and lateral sides, releasing
the collateral ligaments. We worked through the notch and
released the posterior cruciate ligament. Careful attention was
paid to stay on the bone at all times. We worked our way around
the femur and ultimately shelled out in 2 separate pieces the
distal femur with the femoral component on it. It should be
mentioned that prior to doing this, we reduced the fracture and
marked our alignment. We marked our resection for 60 mm, and we
also marked the trochlea on the remaining proximal portion of the
femur so that we could assess rotation adequately. With this
piece removed, we turned our attention to the tibia. The tibia
was exposed medially and laterally around the bone. Oscillating
saw was utilized to free up the cement bone interface, and the
tibial component was removed without difficulty. We removed all
the cement. We set about preparing the tibia. We sized it to a
2.5. We broached for the 45 mm sleeve. We had good stability
with this and impacted it into place. We then reamed the femoral
canal and broached this up with a 34 sleeve. This brought us
right at the cut edge of the femur after making a fresh, new cut.
We then went back and forth with various polyethylenes and
various femoral sizes and adapters until we had good position and
were happy that we had good tracking of the femur. Rotation was
marked and set based on the patellofemoral joint. We were happy
that we had overall good length. The final components were made.
The tibial component was cemented into place. We passed a
cerclage wire cable around the distal portion of the femur to
relieve the hoop stresses. The final component was assembled on
the back table and then impacted into place. It was quite tight
and had quite nice fit of the sleeve in the distal femur. We
went back and forth and tried a couple of different polyethylenes
and settled on a 12 mm polyethylene. This gave us good full
extension and appropriate tension on the soft tissues and the
extensor mechanism. The knee would flex to about 100 degrees
with nice patellar tracking. Happy with this, the wound was
copiously irrigated with antibiotic solution. A single drain was
placed. The soft tissue in the periosteum was closed over the
components up to the suprapatellar pouch. The extensor mechanism
was closed with 0 Vicryl suture in appropriate fashion.