joanne71178
Guru
This is a trauma case; Would 27228 be the correct code? Any thoughts would be much appreciated.
Thanks in advance!
Post OP Diagnosis: Right two-column acetabular fracture with central impaction and dislocation of the hip.
808.0 & 835.00
The patient was transferred onto the OR fracture table and his traction pin was removed. There appeared to be pressure changes to the skin where padding had been utilized to alleviate contact. The pin sites were later cleaned, dried and dressed.
His right hip and pelvis were then prepped and draped in the usual sterile fashion. He had been given a dose of Ancef and a dose of vancomycin was started the skin was then marked out and a surgical pause was performed for an ilioinguinal approach. The skin was infused with local anesthetic and then an incision was then made just above the symphysis pubis curving up to the iliac crest. Dissecttion was then carried down to the symphysis and the abdominal muksculature. The midline was incised over the pubis and then this was used to develop a midline in the rectus musculature. A modified Stoppa approach was then utilized, mobilized in the bladder and peritoneal contents and going beneath the neurovascular bundle. The quadrilateral plate and fracture lines were then identified and these were mobilized and appeared o be fairly well reduced.
With pressure over the quadrilateral plate it appeared that the reduction had improved. A 14-holed Synthes recon plate had been contoured to a model pelvis and this was then sterilized. This was utilized afer creating the iliac window mobilizing the abdominal musculature off of the inner table of the ilium. The lateral femoral cutaneous nerve was identified and preserved applying as a little stretch as possible. A Penrose drain was then passed between the midline incision and the iliac window and this was used for retraction.
The plate was then carefully passed around the contents of the true pelvis sliding just above the bone on the inside of the superior ramus and across the quadrilateral plate then folding over the rim of the true pelvis and then onto the ilium. Modifications to the contour were made and then the plate was anchored using a screw on the the ramus and then retractors were placed and a ball spike was used to compress the plate to the inner table of the true pelvis proximal to the quadrilateral plate. This formed a buttress against the quadrilateral plate.
An additional screw was then added after the first and then these were sequentially tightened down providing good compression. A ball spike was then used to hold the plate along the superior ramus and then a ramus screw was fired from the superior ramus down into the bone. This appeared to give good perches. The most proximal 4 screws of the plate were anchored in the ilium and this appeared to give excellent reduction and stability. The fracture could be palpated and the neurovascular structures appear to be outside of the plate with no compression and no overt evidence of trauma.
The wounds were irrigated and closed in a layered fashion......
Thanks in advance!
Post OP Diagnosis: Right two-column acetabular fracture with central impaction and dislocation of the hip.
808.0 & 835.00
The patient was transferred onto the OR fracture table and his traction pin was removed. There appeared to be pressure changes to the skin where padding had been utilized to alleviate contact. The pin sites were later cleaned, dried and dressed.
His right hip and pelvis were then prepped and draped in the usual sterile fashion. He had been given a dose of Ancef and a dose of vancomycin was started the skin was then marked out and a surgical pause was performed for an ilioinguinal approach. The skin was infused with local anesthetic and then an incision was then made just above the symphysis pubis curving up to the iliac crest. Dissecttion was then carried down to the symphysis and the abdominal muksculature. The midline was incised over the pubis and then this was used to develop a midline in the rectus musculature. A modified Stoppa approach was then utilized, mobilized in the bladder and peritoneal contents and going beneath the neurovascular bundle. The quadrilateral plate and fracture lines were then identified and these were mobilized and appeared o be fairly well reduced.
With pressure over the quadrilateral plate it appeared that the reduction had improved. A 14-holed Synthes recon plate had been contoured to a model pelvis and this was then sterilized. This was utilized afer creating the iliac window mobilizing the abdominal musculature off of the inner table of the ilium. The lateral femoral cutaneous nerve was identified and preserved applying as a little stretch as possible. A Penrose drain was then passed between the midline incision and the iliac window and this was used for retraction.
The plate was then carefully passed around the contents of the true pelvis sliding just above the bone on the inside of the superior ramus and across the quadrilateral plate then folding over the rim of the true pelvis and then onto the ilium. Modifications to the contour were made and then the plate was anchored using a screw on the the ramus and then retractors were placed and a ball spike was used to compress the plate to the inner table of the true pelvis proximal to the quadrilateral plate. This formed a buttress against the quadrilateral plate.
An additional screw was then added after the first and then these were sequentially tightened down providing good compression. A ball spike was then used to hold the plate along the superior ramus and then a ramus screw was fired from the superior ramus down into the bone. This appeared to give good perches. The most proximal 4 screws of the plate were anchored in the ilium and this appeared to give excellent reduction and stability. The fracture could be palpated and the neurovascular structures appear to be outside of the plate with no compression and no overt evidence of trauma.
The wounds were irrigated and closed in a layered fashion......
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