Percutaneous techniques using large reduction clamps or devices and cannulated screw fixation are acceptable, but the surgeon must be certain of anatomic restoration and no interposed tissue. The Ottawa rules determine if a patient requires radiographs. High-level fibula fractures are typically associated with disruption of the syndesmosis, resulting in instability. Cast immobilization typically is effective for management, and bony remodeling usually compensates for any minor malalignments. If the patient has a stable, well-aligned ankle and hindfoot after 12 to 18 months of acute fracture management and bracing, the patient may be weaned from the brace into appropriate footwear. There are multiple classification systems to communicate the specific fracture patterns and help determine treatment options. Doctors classify ankle fractures according to the area of bone that is broken. An isolated medial malleolus fracture should raise the suspicion for a proximal fibula fracture, which is known as a Maisonneuve fracture. Copyright © 2020 Elsevier B.V. or its licensors or contributors. The focus of treatment should be based on congruity of articular reduction because the complications surrounding these injuries arise from nonanatomic incongruous relationships, leading to early degenerative changes rather than the more popular but erroneous presumption of growth arrest. Separations of more than 2 mm in distance along the joint surface, regardless of congruity, should be repaired. synonyms: ORIF Ankle Fracture, open reduction internal fixation ankle, medial malleolus ORIF, lateral malleolus ORIF. Systemic diseases such as osteoporosis, diabetes, peripheral vascular disease, alcoholism, and tobacco abuse can all affect the ultimate outcome of surgery. Any fracture of the ankle with a residual talar tilt or subluxation, in which the ankle mortise is not anatomically reduced, warrants surgical fixation. Preoperative variables that predict a successful outcome include an otherwise healthy patient who is well motivated to recover after surgery. William C. McGarvey, in Baxter's the Foot and Ankle in Sport (Second Edition), 2008. This chapter focuses on supination external rotation bimalleolar ankle fractures, an injury pattern that accounts for up to 75% of ankle fractures. The Danis-Weber/AO classification system (Fig. Salter-Harris (S-H) fractures not involving the joint adhere to principles of all generic, pediatric fracture management protocols (Fig. View calculated CPT fee values specifically for your Medicare locality. Immobilization usually is required for 6 to 8 weeks, at which point gradual weight bearing and range of motion may be advanced as tolerated. The four Lauge-Hansen classes are (the first term in parentheses refers to the foot position and the second term describes the external force applied to the ankle): Supination-External Rotation (SER, 40%–75%), Pronation-External Rotation (PER, 5%–20%), David Walton, Marc A. Zussman, in Case Competencies in Orthopaedic Surgery, 2017. Patients who are victims of high-energy trauma require an evaluation following the Advanced Trauma Life Support (ATLS) protocol. We will briefly explore etiology, mechanisms, fracture characteristics, and treatment goals to provide a background for the greater purpose of discussing rehabilitation guidelines and physical therapy goals as they pertain to different foot and ankle fractures. A detailed analysis of fracture types and surgical management is beyond the scope of this book. Bracing the foot and ankle for hindfoot and ankle fractures would then be utilized for 1 year following the injury to prevent the late development of a Charcot joint. The mechanics of the fracture and its surgical fixation must be understood and appreciated to avoid imposing excessive force or stress on the initial injury. However, exceptions do exist, including paraplegics and quadriplegics, and patients who are nonambulatory and lack sensation to the lower extremities. Evaluate the ankle for open wounds, gross deformity requiring prompt reduction, and neurovascular status of the extremity. Hockenbury MD, in Orthopaedic Physical Therapy Secrets (Third Edition), 2017. Alvin H. Crawford, ... Shital N. Parikh, in Green's Skeletal Trauma in Children (Fifth Edition), 2015, The Dias–Tachdjian pediatric ankle fracture classification has stood the test of time as a useful tool for categorizing and understanding these injuries. James T. Reagan MD, ... John J. Jasko MD, in Clinical Orthopaedic Rehabilitation: a Team Approach (Fourth Edition), 2018. No compromise should be accepted at the articular surface for fear of early degenerative changes. Classically, the lateral followed by the medial malleolus is anatomically reduced and stabilized to restore articular congruity. Save time with a Professional or Facility subscription! Derek Dombroski, Enyi Okereke, in Gowned and Gloved Orthopaedics: Introduction to Common Procedures, 2009. Stress views (external rotation of the foot while taking an anteroposterior ankle radiograph) of the ankle can uncover an unstable ankle fracture that may otherwise appear stable. 5-12). Ankle fractures can be treated conservatively if the ankle mortise remains stable. 300-400 new vignettes are added each year as codes added, revised and reviewed. The authors would estimate that this classification system easily accounts for more than 90% of the nontransitional ankle fractures encountered in children. In each subcategory, the bones or ligaments fail in a specific pattern that can require specific treatment strategies. The following specific injuries are indications for conservative treatment: isolated nondisplaced medial malleolar fracture or tip avulsion fracture, isolated lateral malleolar fracture with less than 3 mm displacement and no talar shift, and a posterior malleolar fracture with less than 25% joint involvement or less than 2-mm stepoff. CPT Code: 27766—Open reduction internal fixation medial malleolus, CPT Code: 27792—Open reduction internal fixation lateral malleolus, CPT Code: 27814—Open reduction internal fixation bimalleolar ankle fracture, CPT Code: 27822—Open reduction internal fixation trimalleloar fracture; medial and lateral malleolus only, CPT Code: 27823—Open reduction internal fixation trimalleolar fracture, medial, lateral, and posterior lip fixation, CPT Code: 27829—Open treatment of distal tibiofibular joint (syndesmosis) disruption, 824.0—Fracture of medial malleolus, closed, 824.2—Fracture of lateral malleolus, closed, 824.3—Fracture of lateral malleolus, open, 824.8—Unspecified fracture of ankle, closed, 824.9—Unspecified fracture of ankle, open, S82.85—Trimalleolar fracture of lower leg, Graham Linck, ... Richard D. Ferkel, in Rehabilitation for the Postsurgical Orthopedic Patient (Third Edition), 2013. Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. Trimalleolar fracture is a fracture of the lateral malleolus, medial malleolus, and posterior aspect of the distal tibial articular surface. Pediatric ankle fractures constitute a wide variety of patterns and complexity. The most common mechanism of an ankle fracture is from forced external rotation with the ankle held fixed in supination (supination-external rotation). Additionally, involvement of the medial malleolus and position of the talus within the mortise is of the utmost importance. Closed anatomic reduction often is successful simply by reversing the mechanism of injury. You will be able to see the most common modifiers billed to Medicare along with this code. Reproduced and adapted with permission from J Bernstein, ed: Musculoskeletal Medicine. Thank you for choosing Find-A-Code, please Sign In to remove ads. 27766 27792 27814 27822 27823 See all Malleolus fx CPT codes; Bimalleolar CPT Coding ORIF Ankle Fracture Indications. 28-2) is based on the level of the fibula fracture in relation to the syndesmosis. Calculated for National Unadjusted (00000), Clinical Labor (Non-Facility)- Direct Expense, Additional Code Information (Global Days, MUEs, etc.). Every vignette contains a Clinical Example/Typical Patient and a description of Procedure/Intra-service.

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