Kelly_Josephine
Networker
I am struggling with coding this olecranon case. I was expecting olecranon to be a part of the ulna... but the op report describes work in the region of the triceps so I am wondering if I am supposed to be interpreting this as part of the humerus? Once I get my geography straight, I still cant seem to find the right code(s) and am considering unlisted... Has anyone seen this before or able to offer insight?
OPERATIVE REPORT:
POSTOPERATIVE DIAGNOSES: Right elbow osteochondral injury and osteochondral defect.
PROCEDURES PERFORMED:
1. Right elbow chevron olecranon osteotomy.
2. Right elbow trochlear osteochondral allograft.
The patient’s right upper extremity was identified and marked in the preoperative area. The patient was then brought into the operating room, where general anesthesia was administered. All bony prominences were well-padded and areas of possible nerve compression were left free. The patient was then prepped and draped in the usual sterile fashion. A 2 g of Ancef was given. A time-out was read.
The patient’s defect was found to be mostly posterior, therefore it was decided to proceed with olecranon
osteotomy to be able to visualize the defect. The arm was exsanguinated with an Esmarch tourniquet was
raised to 250 mmHg for 110 minutes. An incision was made posteriorly curved on the radial aspect of the
olecranon full-thickness flaps were made medially and laterally. The triceps was isolated both on the
medial and lateral intermuscular septum and a chevron osteotomy pointed towards the hand was then
created with a small saw blade and cracking the articular aspect of the joint in order to have jagged edges
that could adequately reduced at the end of the case. The osteotomy site and triceps were then reflected.
Care was taken to ensure at the ulnar was intact. The nerve was isolated.
At this point, the elbow was flexed. The osteochondral injury was identified. It was delineated sharply
with a knife and with ring curettes. It was measured to be an 8 mm diameter. Therefore, an
osteochondral allograft from LifeNet was prepared with a depth of 6 mm and a width of 8 mm. This was
done using the Arthrex OATS donor and recipient system. The recipient site was then reamed with an 8
mm reamer and the definitive plug was then implanted and this was found to be nicely contoured and flat
with respect to the surrounding trochlear cartilage. Care was taken to not do any amounts of tamping in
order to protect chondral sites.
At this point, the elbow was run through range of motion and there was found to be no mechanical blocks
motion. The area was copiously lavaged. The olecranon fragment was then reduced and held with
Weber clamps. A 7-hole one-third tubular plate was then placed posteriorly contoured around the
olecranon and a home run screw in addition to two locking and two 2.7 mm cortical screws were placed in
order to secure the plate and reduced the osteotomy. The osteotomy was found to be reduced
anatomically, it was found to have no diastasis in flexion or extension. The arm had full range of motion.
The area was then copiously lavage. The sites were closed with #0-Vicryl including the triceps to the
plate. Incision was closed with 2-0 Vicryl and 4-0 Monocryl as well as Dermabond, covered with
Xeroform, 4x4s, and Tegaderm. The patient tolerated procedure well.
OPERATIVE REPORT:
POSTOPERATIVE DIAGNOSES: Right elbow osteochondral injury and osteochondral defect.
PROCEDURES PERFORMED:
1. Right elbow chevron olecranon osteotomy.
2. Right elbow trochlear osteochondral allograft.
The patient’s right upper extremity was identified and marked in the preoperative area. The patient was then brought into the operating room, where general anesthesia was administered. All bony prominences were well-padded and areas of possible nerve compression were left free. The patient was then prepped and draped in the usual sterile fashion. A 2 g of Ancef was given. A time-out was read.
The patient’s defect was found to be mostly posterior, therefore it was decided to proceed with olecranon
osteotomy to be able to visualize the defect. The arm was exsanguinated with an Esmarch tourniquet was
raised to 250 mmHg for 110 minutes. An incision was made posteriorly curved on the radial aspect of the
olecranon full-thickness flaps were made medially and laterally. The triceps was isolated both on the
medial and lateral intermuscular septum and a chevron osteotomy pointed towards the hand was then
created with a small saw blade and cracking the articular aspect of the joint in order to have jagged edges
that could adequately reduced at the end of the case. The osteotomy site and triceps were then reflected.
Care was taken to ensure at the ulnar was intact. The nerve was isolated.
At this point, the elbow was flexed. The osteochondral injury was identified. It was delineated sharply
with a knife and with ring curettes. It was measured to be an 8 mm diameter. Therefore, an
osteochondral allograft from LifeNet was prepared with a depth of 6 mm and a width of 8 mm. This was
done using the Arthrex OATS donor and recipient system. The recipient site was then reamed with an 8
mm reamer and the definitive plug was then implanted and this was found to be nicely contoured and flat
with respect to the surrounding trochlear cartilage. Care was taken to not do any amounts of tamping in
order to protect chondral sites.
At this point, the elbow was run through range of motion and there was found to be no mechanical blocks
motion. The area was copiously lavaged. The olecranon fragment was then reduced and held with
Weber clamps. A 7-hole one-third tubular plate was then placed posteriorly contoured around the
olecranon and a home run screw in addition to two locking and two 2.7 mm cortical screws were placed in
order to secure the plate and reduced the osteotomy. The osteotomy was found to be reduced
anatomically, it was found to have no diastasis in flexion or extension. The arm had full range of motion.
The area was then copiously lavage. The sites were closed with #0-Vicryl including the triceps to the
plate. Incision was closed with 2-0 Vicryl and 4-0 Monocryl as well as Dermabond, covered with
Xeroform, 4x4s, and Tegaderm. The patient tolerated procedure well.