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View Full Version : Elbow fracture/dislocation


Amzie
08-17-2012, 01:58 PM
Hello coders, I need some assistance on what code to choose for this op report. I have all the others but I cant choose between these two: 24586 vs 24685 and why you would choose this code. Here is the op report,
thanks in advance!

DX: displaced olecranon fx dislocation with fx of coronoid process as well as comminuted radial head fx and elbow dislocation

ORIF olecranon fx/proximal ulna
ORIF coronoid process fx
Radial head arthroplasty
Repair of LCL and MCL

Procedure performed:
I made a curvillinear incision around the olecranon process. The incision was taken down through the skin and subcutaneous tissues. I isolated the fascia very carefully and subsequently incised between the ECU and FCU and then all the way carefully up to the fracture site. Teh proximal ulna was very rotatetd and the bone was tenting the skin. There was some whiteness of the skin. I then carefully dissected out the ulnar nerve. I did a very gently reduction of the proximal ulna to be able to see the landmarks. I then very gently dissected out the ulnar nerve and protected it. The FCU was very badly torn by the fragments. There was severe comminution and I very carefully removed using forceps the radial head fragments both posteior and anterior to the capitellum. There was significatn amount of abrasion in the posterior part of the capitullum and some in the anterolateral portion of the capitellum too. This was grade 2a and 2b and then I reduced. There was a split in the diaphysis of the proximal ulna and I fixated it. Then I pieced together other small fragments in this area. I then reduced the olecranon to this. Prior to doing this I placed some sutures throught the coronoid process in a diamond type fashion and I abraded the tip of the coronoid as a tip fracture. There was also an avulsion process fracture at the MCL origion and another small articular fracture at the edge of the proximal ulnar greatere sigmoid notch. I was able to reduce the proximal ulna and fixated the proximal ulna together with all the various fragments. I had to use a 20.mm as well as a 1.5mm synthes plates in orger to get some cortical reduction to try to achieve appropriate position. I applied a very long acumed proximal olecranon plate and fixated this centrally. It was subsequently fixated proximall and distally using a combonation of locking screws and compression screws.
Attention was turned to the radial head. I entered the canal and broached the canal upt to a size 9. I confirmed in situ that it was just at the proximal region of the PRUJ. Then the permament prosthesis was placed and then repaired the LCL and MCL.

then it just goes on about the ligament repairs.

Any suggestions?