I need some assistance on this op report. Patient has a malunion of the metacarpal and carpometacarpal and the doctor repaired these, but there are no cpt codes for this???
Procedure performed:
ORIF with bone graft of fourth metacarpal base fracture malunion
Rt hand fifth carpometacarpal joint fracture dislocation malunion open reduction and internal fixation with bone graft
OP note:
We exanguinated the limb and raised the tourniquet. Upon examing the hand it did become more apparent to me that the patient had some signs of adductor as well as previously noted clawing of the ring finger. However it was also noted that the patient had a significant prominence over his fourth and fifth carpometacarpal joints as well as shortening and volar sublaxation of the metacarpals. I attempted to perform a closed reduction but thiese fractures were completely healed. For this reason I made a longitudinal incision over the fourth and fifth carpometacarpal joints. At the base of the fifth carpometacarpal joint I could see that the base of the metacarpal was dislocated with a significant avulsion type fracture off of the hamate. I was able to excavate this and open this area up. I was able to somewhat mobilize the fifth metacarpal, however with pulling traction I was still not able to bend the fourth metacarpal. I opened up this area and used the rongeur to open up the area of healing bone. It required an osteotome over the fourth metacarpal to free up this previously volarly angulated fracture. By pulling traction on this Iwas able to re establish a normal length of the metacarpal and pull the fifth metacarpal back to a reduced position. I then pinned with a K wire across from the fifith, fourth to the third metacarpals. Thie helped to hold the metacarpals out to length.Placing dorsal pressure on the base of the fifth carpometacarpal joint I placed a second K wire from the base of the fifth carpometacarpal into the carpus of the hand. I elected to perform a second K wire across the third, fourth and fifth metacarpals in order to reinforce this and hold it out to length. At the completion of this the hand had much more normal apperance/ F;exion and extension of the fingers showed normal position of the metacarpal heads. However, at the area of the malunion at the base of the fourth metacarpal there appeared to be a significant gap in the bone of approximately 4-5mm. I dissected over to Listers tubercle. I carefully protected the tendons but removed the roof of this bone. I took cancellous bone graft from the distal radius and I was able to fully pack the fourth metacarpal base with this bone graft. He then closed the wound...
Any advice would be great!! Thanks in advance
Procedure performed:
ORIF with bone graft of fourth metacarpal base fracture malunion
Rt hand fifth carpometacarpal joint fracture dislocation malunion open reduction and internal fixation with bone graft
OP note:
We exanguinated the limb and raised the tourniquet. Upon examing the hand it did become more apparent to me that the patient had some signs of adductor as well as previously noted clawing of the ring finger. However it was also noted that the patient had a significant prominence over his fourth and fifth carpometacarpal joints as well as shortening and volar sublaxation of the metacarpals. I attempted to perform a closed reduction but thiese fractures were completely healed. For this reason I made a longitudinal incision over the fourth and fifth carpometacarpal joints. At the base of the fifth carpometacarpal joint I could see that the base of the metacarpal was dislocated with a significant avulsion type fracture off of the hamate. I was able to excavate this and open this area up. I was able to somewhat mobilize the fifth metacarpal, however with pulling traction I was still not able to bend the fourth metacarpal. I opened up this area and used the rongeur to open up the area of healing bone. It required an osteotome over the fourth metacarpal to free up this previously volarly angulated fracture. By pulling traction on this Iwas able to re establish a normal length of the metacarpal and pull the fifth metacarpal back to a reduced position. I then pinned with a K wire across from the fifith, fourth to the third metacarpals. Thie helped to hold the metacarpals out to length.Placing dorsal pressure on the base of the fifth carpometacarpal joint I placed a second K wire from the base of the fifth carpometacarpal into the carpus of the hand. I elected to perform a second K wire across the third, fourth and fifth metacarpals in order to reinforce this and hold it out to length. At the completion of this the hand had much more normal apperance/ F;exion and extension of the fingers showed normal position of the metacarpal heads. However, at the area of the malunion at the base of the fourth metacarpal there appeared to be a significant gap in the bone of approximately 4-5mm. I dissected over to Listers tubercle. I carefully protected the tendons but removed the roof of this bone. I took cancellous bone graft from the distal radius and I was able to fully pack the fourth metacarpal base with this bone graft. He then closed the wound...
Any advice would be great!! Thanks in advance