aknapp1117
New
Hi everyone,
I am in need of some education from more experienced orthopedics/trauma specialty coders. I have a case where a trauma dr documented a "Masquelet technique for management of large bone defects" procedure:
"...The same bone void that was there previously was reassessed. The alignment was appropriate. I didn't see any significant worsening of the soft tissue and felt overall he had a reasonably stable bed. I irrigated with 9 L of normal saline and debrided any tissue felt was tenuous area this included some skin and muscle and bone. I then turned my attention to the medial side. I assessed where the posterior medial aspect of the tibia was. I measured it to the anterior wound and had at least 7 cm but mostly 7-10 cm. Posteriorly was at least 12. I then performed a standard posterior medial approach. Became very evident that he hadn't had a severe crush injury to his leg and the soft tissue was very contused. Any nonviable tissue was removed. I dissected directly down onto his posterior medial tibia. I did not think it is worth salvaging hamstrings in this particular situation and therefore cut through them. The footprint for the plate was made. Using a sharp reduction clamp I reduced the proximal fracture to the tibial shaft. The fracture had initially been extension and this realigned. I then chose an appropriate length plate to give me enough screws distal to the fracture itself but also proximal to the pin sites of the ex-fix. I then attached the plate to the distal bone with a single cortical screw. I checked the locking trajectory on the proximal screws and I did not like where it was directly and therefore opted to put in non-lockers proximally. I could skirt the subchondral bone. I inserted 4 proximal screws and 3 more distal screws all of them were non-lockers. Because of this I did not think that my construct was stable enough in isolation. I therefore opted to apply a short lateral plate with only a single screw distally. The benefit of this is that I could contain the bone cement between the 2 plates and the bone and I could use the cement to screw into 2 enhance my stability. Once the lateral plate was applied about 2 bags of tobramycin cement and added 6 g of vancomycin. It was hand mixed. When doughy I pressed it into the bone void. I did not push it far down the canal and simply filled in the proximal lateral tibia that I felt was deficient. Once in the appropriate position and hardened I drilled into the bone cement and inserted 2 cortical screws. Final fluoroscopy shots were taken demonstrated appropriate alignment and appropriate position of the bone cement with no leakage out of the bone into concerning laces...."
I will capture the ORIF RT Tibia, but I haven't seen a staged Masquelet before.
Thanks for the help,
Aubrey
I am in need of some education from more experienced orthopedics/trauma specialty coders. I have a case where a trauma dr documented a "Masquelet technique for management of large bone defects" procedure:
"...The same bone void that was there previously was reassessed. The alignment was appropriate. I didn't see any significant worsening of the soft tissue and felt overall he had a reasonably stable bed. I irrigated with 9 L of normal saline and debrided any tissue felt was tenuous area this included some skin and muscle and bone. I then turned my attention to the medial side. I assessed where the posterior medial aspect of the tibia was. I measured it to the anterior wound and had at least 7 cm but mostly 7-10 cm. Posteriorly was at least 12. I then performed a standard posterior medial approach. Became very evident that he hadn't had a severe crush injury to his leg and the soft tissue was very contused. Any nonviable tissue was removed. I dissected directly down onto his posterior medial tibia. I did not think it is worth salvaging hamstrings in this particular situation and therefore cut through them. The footprint for the plate was made. Using a sharp reduction clamp I reduced the proximal fracture to the tibial shaft. The fracture had initially been extension and this realigned. I then chose an appropriate length plate to give me enough screws distal to the fracture itself but also proximal to the pin sites of the ex-fix. I then attached the plate to the distal bone with a single cortical screw. I checked the locking trajectory on the proximal screws and I did not like where it was directly and therefore opted to put in non-lockers proximally. I could skirt the subchondral bone. I inserted 4 proximal screws and 3 more distal screws all of them were non-lockers. Because of this I did not think that my construct was stable enough in isolation. I therefore opted to apply a short lateral plate with only a single screw distally. The benefit of this is that I could contain the bone cement between the 2 plates and the bone and I could use the cement to screw into 2 enhance my stability. Once the lateral plate was applied about 2 bags of tobramycin cement and added 6 g of vancomycin. It was hand mixed. When doughy I pressed it into the bone void. I did not push it far down the canal and simply filled in the proximal lateral tibia that I felt was deficient. Once in the appropriate position and hardened I drilled into the bone cement and inserted 2 cortical screws. Final fluoroscopy shots were taken demonstrated appropriate alignment and appropriate position of the bone cement with no leakage out of the bone into concerning laces...."
I will capture the ORIF RT Tibia, but I haven't seen a staged Masquelet before.
Thanks for the help,
Aubrey