Here is the scenario:

Pt dx is septic olecranon bursitis with nonhealing ulcer and bone scan positive for osteomyelitis to the olecranon

Procedure: 1. I & D with lavage left elbow 2. Bursectomy left olecranon bursa 3. Bone biopsy left olecranon 4. Intraoperative cultures left elbow
5. Posterior splint

A 15 blade was used to make approx 6 cm incision. The nonhealing ulcer was ellipsed in mass. Careful dissection was carried down to the olecranon bursa and wide bursectomy was performed. Care was taken to assure neurovascular structures were not in harms way. There was a small rent in the fascia noted directly over the area of the olecranon. There was purulence noted within the small cavitary defect within the bone. Sharp excision of devitalized soft tissue was performed. A curette was used to further debride that area. It should be noted both superficial and deep aerobic and anaerobic cultures were obtained superficial in the bursa and deep within the cavitary lesion of the bone of the olecranon. Multiple soft tissue specimens were sent for frozen section as well as culture and sensitivity and pathology. Once completed and once satisfied with sharp debridement the would was copiously irrigated with normal saline solution with antibiotic impregnation. The second sharp debridement was carried out. Once this was completed a bone biopsy was performed utilizing the Zimmer biopsy set, small core bone was removed under direct visualization from the tip of the olecranon and sent for frozen section and pathology. Once satisfied the wound was finally irrigated and final debridement was carried out. Our tourniquet was let down and hemostasis was readily obtained utilizing electrocautery. A small amoutn of Monocryl was used to approximate the margins of skin. The skin was closed over a 0.25 ince Penrose drain and the skin was approximated with 3-0 nylon in a horizontal mattress fashion. .......etc.

We are having a hard time on this one.....24105 and 20220....but we don't know if we include 23935 and then we are wondering if 24138 is appropriate.....

Any advice is greatly appreciated...thanks