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perc pinning or open treatment

abevan

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I have a Dr and an office manager that are confusing me. Dr says in the title of the op note that it is perc pinning but when you read the op note he states that he made a stab incision, office manager says because it is a incision it is open???? Please help!!!
 

abevan

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I first attempted manipulative reduction by doing an "anterior drawer" type maneuver pulling the ankle and distal tibia anterior to the posterior tibia in order to reduce the posterior displacement. Then reduced the opening of the physis on the lateral aspect of the distal tibia by applying a compressive and varus force across the fracture. The fracture was then imaged in multiple planes. It was felt that the fracture was reduced anatomically. I elected to fix this with a single percutaneous cannulated screw.

Examination of the fracture pattern on CT demonstrated that the ideal placement would be from the posterior lateral corner of the tibia going anterior. A guidewire was placed into the posterior lateral tibia extending both anterior and medial well proximal to the growth plate. A small incision was made over the guidewire. Soft tissues carefully spread down to bone and the depth gauge measurement taken directly off the guidewire. A 30 mm 3.0 Synthes cannulated screw was then inserted. Satisfactory placement of the hardware and maintenance of the anatomic reduction was confirmed with image intensification in multiple planes and permanent images were made. The wound was irrigated.

The would was closed with 2 interrupted nylon sutures and infiltrated with 2 mL of 0.25% Marcaine with epinephrine. A sterile dressing was applied incorporated into a very well padded posterior splint. The patient was taken to the recovery room in good condition having tolerated the procedure well. The patient received 1 gram of Ancef intravenous prior to the onset of the procedure and a second gram of Ancef intravenous in the recovery room.
 

mbort

True Blue
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ENGLEWOOD/DENVER
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This was more than a perc pinning, he actually inserted screws. Definitely an open procedure. More than a "stab" incision was made. It was small, but nonetheless, still an incision in which exposed down to the bone to insert the screw.
 
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