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Medical Policy Ultrasound Accelerated Fracture Healing Device
Medical Policy Ultrasound Accelerated Fracture Healing Device Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies Policy: Medicare Description References Authorization Information Policy History Policy Number: 497 BCBSA Reference Number: 1.01.05 Related Policies Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures, #498 Electrical Bone Growth Stimulation of the Appendicular Skeleton, #499 Bone Morphogenetic Protein, #097 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Members Low-intensity ultrasound treatment may be MEDICALLY NECESSARY when used as an adjunct to conventional management (i.e., closed reduction and cast immobilization) for the treatment of fresh, closed fractures in skeletally mature individuals. Candidates for ultrasound treatment are those at high risk for delayed fracture healing or nonunion. These risk factors may include either locations of fractures or patient comorbidities and include the following: Patient comorbidities: Diabetes, Steroid therapy, Osteoporosis, History of alcoholism, History of smoking. Fracture locations: Jones fracture, Fracture of navicular bone in the wrist (also called the scaphoid), Fracture of metatarsal, Fractures associated with extensive soft tissue or vascular damage. Low-intensity ultrasound treatment may be MEDICALLY NECESSARY as a treatment of delayed union of bones, including delayed union** of previously surgically-treated fractures, and excluding the skull and vertebra. 1 Low-intensity ultrasound treatment may be MEDICALLY NECESSARY as a treatment of fracture nonunions of bones, including nonunion*** of previously surgically-treated fractures, and excluding the skull and vertebra. Other applications of low-intensity ultrasound treatment are INVESTIGATIONAL, including, but not limited to, treatment of congenital pseudarthroses, open fractures, fresh* surgically-treated closed fractures, stress fractures, arthrodesis or failed arthrodesis. -
Bimalleolar Ankle Fracture Fixation of a 13-Year-Old Patient with Two Activascrew™ LAG Bioabsorbable Screws
Bimalleolar ankle fracture fixation of a 13-year-old patient with two ActivaScrew™ LAG bioabsorbable screws. Pierre Lascombes Professor, M.D., Ph.D. For medical professional use, not public. © 2020 Bioretec Ltd. and Prof. Lascombes. All rights reserved. Table of Contents Summary Table ........................................................................................................... 3 1 Case Description .................................................................................................. 4 2 Implants and operative technique ......................................................................... 5 3 Outcome ............................................................................................................... 7 4 Contact Information Concerning the Case ............................................................ 8 For medical professional use, not public Page 2 / 8 © 2020 Bioretec Ltd., Prof. Lascombes. All rights reserved. Summary Table Demographics Patient number: P01 Patient Initials: NX Smoking: No Sex: Female Use of alcohol: No Age: 13 Years Systemic disease: No Height: 158 cm Cont. Medication: No Weight: 40 kg Case description Diagnosis: Dislocation right ankle - bimalleolar fracture Cause of injury: Gymnastic injury Operation Operator: Lascombes Operation year: 2016 Note: Immediate reduction of the Operation description: Open reduction of medial malleolus and fixation with TWO resorbable screws dislocation at emergenry room - ketamine. Surgical treatment 5 hours Operation time:h57 min Immobilisation -
5Th Metatarsal Fracture
FIFTH METATARSAL FRACTURES Todd Gothelf MD (USA), FRACS, FAAOS, Dip. ABOS Foot, Ankle, Shoulder Surgeon Orthopaedic You have been diagnosed with a fracture of the fifth metatarsal bone. Surgeons This tyPe of fracture usually occurs when the ankle suddenly rolls inward. When the ankle rolls, a tendon that is attached to the fifth metatarsal bone is J. Goldberg stretched. Because the bone is weaker than the tendon, the bone cracks first. A. Turnbull R. Pattinson A. Loefler All bones heal in a different way when they break. This is esPecially true J. Negrine of the fifth metatarsal bone. In addition, the blood suPPly varies to different I. PoPoff areas, making it a lot harder for some fractures to heal without helP. Below are D. Sher descriPtions of the main Patterns of fractures of the fifth metatarsal fractures T. Gothelf and treatments for each. Sports Physicians FIFTH METATARSAL AVULSION FRACTURE J. Best This fracture Pattern occurs at the tiP of the bone (figure 1). These M. Cusi fractures have a very high rate of healing and require little Protection. Weight P. Annett on the foot is allowed as soon as the Patient is comfortable. While crutches may helP initially, walking without them is allowed. I Prefer to Place Patients in a walking boot, as it allows for more comfortable walking and Protects the foot from further injury. RICE treatment is initiated. Pain should be exPected to diminish over the first four weeks, but may not comPletely go away for several months. Follow-uP radiographs are not necessary if the Pain resolves as exPected. -
Effect of Manual Reduction and Indirect Decompression on Thoracolumbar Burst Fracture: a Comparison Study
Effect of manual reduction and indirect decompression on thoracolumbar burst fracture: a comparison study Jian Huang ( [email protected] ) Haikou Hospital of Traditional Chinese Medicine https://orcid.org/0000-0002-5434-1148 Limin Zhou Haikou Hospital of Traditional Chinese Medicine Zhaodong Yan Shaoxing Hospital of Traditional Chinese Medicine Zongbo Zhou Haikou Hospital of Traditional Chinese Medicine Xuejian Gou Haikou Hospital of Traditional Chinese Medcine Research article Keywords: Manipulative reduction, Indirect decompression, Thoracolumbar burst fractures Posted Date: October 14th, 2020 DOI: https://doi.org/10.21203/rs.3.rs-90414/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Version of Record: A version of this preprint was published on November 13th, 2020. See the published version at https://doi.org/10.1186/s13018-020-02075-w. Page 1/16 Abstract Study design Retrospective cohort study. Objective To evaluate the effect of manual reduction and indirect decompression on thoracolumbar burst fracture. Methods 60 patients with thoracolumbar burst fracture who were hospitalized from January 2018 to October 2019 were selected and divided into experimental group (33 cases) and control group (27 cases) according to different treatment methods. The experimental group was treated with manual reduction and indirect decompression, while the control group was not treated with manual reduction. The operation time and intraoperative blood loss were recorded. VAS score was used to evaluate the improvement of pain. The anterior height of injured vertebra, wedge angle of injured vertebral body, encroachment ratio of injured vertebral canal were used to evaluate spinal canal decompression and fracture reduction. -
ASSESSMENT of FIFTH METATARSAL ETIOLOGY Daniel Reed Clemson University, [email protected]
Clemson University TigerPrints All Theses Theses 7-2008 ASSESSMENT OF FIFTH METATARSAL ETIOLOGY Daniel Reed Clemson University, [email protected] Follow this and additional works at: https://tigerprints.clemson.edu/all_theses Part of the Biomedical Engineering and Bioengineering Commons Recommended Citation Reed, Daniel, "ASSESSMENT OF FIFTH METATARSAL ETIOLOGY" (2008). All Theses. 428. https://tigerprints.clemson.edu/all_theses/428 This Thesis is brought to you for free and open access by the Theses at TigerPrints. It has been accepted for inclusion in All Theses by an authorized administrator of TigerPrints. For more information, please contact [email protected]. ASSESSMENT OF FIFTH METATARSAL FRACTURE ETIOLOGY A Thesis Presented to the Graduate School of Clemson University In Partial Fulfillment of the Requirement for the Degree Master of Science Bioengineering by Daniel Reed August 2008 Accepted by: Dr. Martine Laberge, Committee Chair Dr. Lisa Benson Dr. Larry Bowman MD ABSTRACT The fifth metatarsal “Jones Fracture” is a fracture that occurs 3.5cm distal to the tuberosity. It is an injury that is common in athletes, especially those who participate in sports with a lot of lateral movement. The Jones Fracture is known for its difficulty to heal due to non-union and re-fracture. There has been much research recently regarding in-shoe pressure distributions and their relation to shoe type, movement, and shoe surface interaction. However, only the forces along the bottom of the foot have been investigated. Literature and the direction of fracture seem to implicate a force on the lateral portion of the foot is the cause of the fracture though the exact causal forces are still largely unknown. -
Case Report: Atypical Metatarsal Fracture in a Patient on Long- Term Bisphosphonate Therapy
November 2019. Volume 6. Number 4 Case Report: ATypical Metatarsal Fracture in a Patient on Long- Term Bisphosphonate Therapy Bijan Valiollahi1 , Mostafa Salehpour1 , Hamidreza Bashari1 , Shoeib Majdi1 , Mehdi Mohammadpour1 * 1. Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran. Use your device to scan and read the article online Citation Valiollahi B, Salehpour M, Bashari H, Majdi Sh, Mohammadpour M. ATypical Metatarsal Fracture in a Patient on Long-Term Bisphosphonate Therapy. Journal of Research in Orthopedic Science. 2019; 6(4):25-30. http://dx.doi.org/10.32598/ JROSJ.6.4.67 : http://dx.doi.org/10.32598/JROSJ.6.4.67 A B S T R A C T Bisphosphonates, more particularly alendronate, are a popular category of drugs in the treatment Article info: of postmenopausal and corticosteroid-induced osteoporosis. The present study contends that the Received: 13 May 2019 long-term consumption of bisphosphonates causes not only subtrochanteric and femoral shaft Revised: 27 May 2019 fractures but also pathological fractures at other musculoskeletal sites. This report presents a Accepted: 16 Sep 2019 rare case of alendronate-induced pathological metatarsal fracture in a 59-year-old female with a Available Online: 01 Nov 2019 history of cuboid fracture following a twisting with abnormal Bone Mineral Density (BMD) (T score: −3.5; lumbar spine and −2.6; proximal femur). Keywords: Alendronate, Pathologic Fracture, Metatarsal 1. Introduction ally, drugs such as bisphosphonates contribute to devel- oping bone fractures. tress fractures occur as a result of repetitive loading and unloading of a bone [1]. In- Bisphosphonates are preferred drugs in postmenopaus- creased strain or frequency of compression al and corticosteroid-induced osteoporosis [6]. -
Bimalleolar Fracture of Ankle Joint Managed by Tension Band Wiring Technique: a Prospective Study Dr
Scholars Journal of Applied Medical Sciences (SJAMS) ISSN 2320-6691 (Online) Sch. J. App. Med. Sci., 2014; 2(1D):428-432 ISSN 2347-954X (Print) ©Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources) www.saspublisher.com Research Article Bimalleolar Fracture of Ankle Joint Managed By Tension Band Wiring Technique: A Prospective Study Dr. Maruthi CV*1, Dr.Venugopal N2, Dr. Nanjundappa HC2, Dr. Siddalinga swamy MK2 1Assistant Professor, Department of Orthopaedics, MVJ MC and RH, Hoskote, Bangalore, India 2Professor, Dept of Orthopaedics, MVJ MC and RH, Hoskote, Bangalore, India 3MVJ Medical College & Research Hospital, Hoskote, Bangalore -562 114, India *Corresponding author Dr. Maruthi CV Email: Abstract: Ankle fractures are the most commonly encountered by most of the orthopaedic surgeons. According to the lauge Hansen’s classification five different types can be seen. The surgical treatment of adduction, abduction and supination external rotation type of injuries leading to bimalleolar fractures can be fixed with either tension band technique or cancellous screws. Here we are done a study to evaluate the benefits of tension band wiring technique in the management of bimalleolar fractures of the ankle. In our study, 40 cases of bimalleolar fracture of ankle joint of above mentioned types were admitted in Department of Orthopaedics, between February 2009 and November 2013 was included. We included patients above 20 and below 58 years. We excluded patients with pronation external rotation, vertical compression and trimalleolar fractures, pathological fractures, compound fractures and who are medically unfit and at extremely high anaesthesia risk. All the patients, operated by open reduction and internal fixation using tension band wiring technique. -
The Michigan Trauma Quality Improvement Program
What Drives your Coding? Diagnoses Kathy Cookman 11:00 What Drives Your Coding? DIAGNOSES Kathy J. Cookman, BS, CSTR, CAISS, EMT-P, FMN CEO – KJ Trauma Consulting, LLC International Technical Coordinator/AIS Course director - AAAM Objectives Identify injuries and correct ICD-10-CM and AIS coding Incorporate education of diagnosis coding Incorporate Anatomy and Physiology Rules for coding, specific to diagnoses identified within scenarios Abstracting: Best Practice Consistency in process Read the details Work concurrently Ask questions/seek clarification Work with CDI team (clinical documentation improvement team) Determine core dataset Assigning ICD-10-CM Use a CURRENT ICD-10-CM coding book Start with the INDEX Find the beginning components of the code Turn to the TABULAR section Complete the code Enter the appropriate code into the trauma registry ICD-10-CM Placeholder “X” Assigning AIS Use the most current AIS Dictionary supported by your trauma registry Find the most appropriate AIS code Enter the code into the trauma registry JJ Krash Transfer – 17 year old boy. Unrestrained passenger seated in the 3rd row. From scene to Level 3 Trauma Center. Transferred to burn center with 8% TBSA burns via ALS ambulance. Diagnoses: 8% TBSA – 3rd degree RLW – circumferential 1st degree RUE – right forearm Hypothermia – 34.9 JJ Krash Develop a method for abstracting data and be consistent in searching cases the same way each time ED Trauma Flow Sheet Drawings “Area of Injury” can be helpful for external skin injury identification, however, be aware that it may be difficult to determine exactly what is noted, where and how complex – always look for more definitive information TBSA Percentage? Extremity Comments = “12% TBSA” Nursing Note Narrative = “12% TBSA” History & Physical = “8% TBSA” What do you do with a discrepancy? JJ Krash Unrestrained passenger seated in the 3rd row of van which lost control, went down a ditch, rolled over and vehicle caught fire. -
Moda Health Plan, Inc. Medical Necessity Criteria
Moda Health Plan, Inc. Subject: Bone Growth Stimulators- Medical Necessity Criteria Ultrasound Page 1 of 8 Origination Date: 01/07 Revision Date(s): 1/08, 1/09, 2/11, 1/12, 09/12, 07/13, 06/14, 09/14, 05/15, 07/15 Developed By: Medical Criteria Committee 01/07 Approved: Mary Engrav, MD Date: 05/27/2015 Description: Bone growth stimulation is a technique of promoting bone growth in difficult to heal fractures. Two types of bone growth stimulators currently exist: electrical and ultrasonic. Ultrasonic fracture healing is a noninvasive treatment that utilizes low intensity, pulsed ultrasound delivered through a skin surface transducer placed directly over the fracture site. It is used to accelerate healing of fresh fractures and fracture nonunions of sites that are difficult to heal because of poor vascular supply. It is frequently used in conjunction with orthopedic treatments such as a cast or splint. The device is portable and can be used by the patient at home in daily 20 minute sessions. The Sonic Accelerated Fracture Healing System (SAFHS) is a type of ultrasound bone growth stimulator. Criteria: I. Ultrasonic Bone Growth Stimulators (CWQI HCS-0008A) A. Ultrasonic bone growth stimulators will be covered to plan limitations for skeletally mature individuals when 1 or more of the following criteria are met: 1. Fresh Acute Fractures a. Most fresh fractures heal with the use of standard fracture care such as closed reduction and cast immobilization. Ultrasonic bone growth stimulators may be indicated for the treatment of fresh fractures when 1 (one) or more of the following risk factors for delayed fracture healing or nonunion are present: i. -
Lower Extremity Fracture Eponyms (Part 2) Philip Kin-Wai Wong1, Tarek N Hanna2*, Waqas Shuaib3, Stephen M Sanders4 and Faisal Khosa2
Wong et al. International Journal of Emergency Medicine (2015) 8:25 DOI 10.1186/s12245-015-0076-1 REVIEW Open Access What’s in a name? Lower extremity fracture eponyms (Part 2) Philip Kin-Wai Wong1, Tarek N Hanna2*, Waqas Shuaib3, Stephen M Sanders4 and Faisal Khosa2 Abstract Eponymous extremity fractures are commonly encountered in the emergency setting. Correct eponym usage allows rapid, succinct communication of complex injuries. We review both common and less frequently encountered extremity fracture eponyms, focusing on imaging features to identify and differentiate these injuries. We focus on plain radiographic findings, with supporting computed tomography (CT) images. For each injury, important radiologic descriptors are discussed which may need to be communicated to clinicians. Aspects of management and follow-up imaging recommendations are included. This is a two-part review: Part 1 focuses on fracture eponyms of the upper extremity, while Part 2 encompasses fracture eponyms of the lower extremity. Keywords: Eponyms; Fractures; Lower extremities; Imaging Introduction Review: Lower extremity fracture eponyms Eponyms are embedded throughout medicine; they Pipkin fracture can be found in medical literature, textbooks, and Femoral head fractures are relatively uncommon and even mass media. Their use allows physicians to are typically associated with hip dislocations after se- quickly provide a concise description of a complex vere high-impact trauma such as a motor vehicle colli- injury pattern. Eponymous extremity fractures are sion. Femoral head fractures are commonly grouped commonly encountered in the emergency setting and into the Pipkin classification (see Table 1) after the work are frequently used in interactions amongst radiolo- of the orthopedic surgeon Garrett Pipkin in 1957 (Fig. -
Lumbar Spine Burst Fracture As a Result of Hypoglycaemia Induced Seizure
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Injury Extra 42 (2011) 25–28 Contents lists available at ScienceDirect Injury Extra journal homepage: www.elsevier.com/locate/inext Case report Lumbar spine burst fracture as a result of hypoglycaemia induced seizure S.A. Malik *, A. Mitra, K. Bashir, A. Mahapatra Trauma and Orthopaedic Department, Our Lady of Lourdes Hospital, Drogheda, Ireland Her American Spinal Injury Association (ASIA) examination was ARTICLE INFO normal with no signs of cord compression. She had full control over Article history: her bowel and bladder function. She had reduced power in the Accepted 10 November 2010 lower limbs bilaterally which was attributed to pain. The focal tenderness was confirmed, with no other obvious tender points over the spinous processes. Computer tomogram demonstrated an 1. Introduction isolated burst fracture at the level of L2 involving the anterior and middle column with retropulsion into the spinal canal. The canal It has been reported in literature that vertebral fractures can was reduced to 8 mm diameter. Her case was discussed with the occur as a consequence of seizures. Muscle forces alone during specialist spinal unit for second opinion and treatment was by tonic–clonic seizures can result in severe musculo-skeletal injuries conservative management. She was fitted with a lumbar spine which include vertebral fractures, neck of femur fractures, support brace (C37) and mobilised next day with analgesic support proximal humeral fractures and dislocations of shoulder. and physiotherapy guidance. She made good recovery and was We report the case of a 42 years old lady, who sustained burst discharged in two days with adequate independent mobilisation fracture of second lumbar vertebra with mild retropulsion as a with analgesic control for her pain. -
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Metatarsal Fracti]Res
METATARSAL FRACTI]RES Bradley D. Castellano, DPM Stepben V. Corey, DPM TbomasJ. Merrill, DPM John A. Rucb, DPM As with many common disorders of the foot, the displaced fractures, stress fractures, joint disloca- area of metatarsal fractures has received only tions, intra-articular fractures, severely comminut- superficial attention in historical and current med- ed and even compound fractures. The sllrgeon ical and surgical discr-rssions. General principles must have a thorough working knowledge of of fracture management have been sparingly these injuries in the specific region and unique applied to the topic in most ofihopedic and podi- anatomy of the forefoot. The full scope of poten- atric texts. The fifth metatarsal, however, has tial injury must be appreciated to avoid misdiag- received some degree of attention uncler the nosis and inappropriate treatment. eponym of the Jones' fracture. The eponym how- The variety of injuries to the metatarsal ever is often misapplied to the common avulsion region can be systematically classified. This type fracture of the fifth metatarsal base. Most refer- of classification can serve the same purpose as ences ciealing with the subject are interesting per- the Lauge-Hansen system in ankle fractures. A sonal experiences with metatarsal fractures and working knowledge of the mechanism of injury is an attempt to introduce a new or re-visited tech- also the key to successful management of many nique for the management of a unique or bizarre of the common injuries through conservative injury. Figura presents a iogical and rather com- methods or closed reduction techniques. plete classification of metatarsal fractures and dis- Complete clinical and radiographic evalua- cusses treatment.l tion are essential stepping stones in the success- State of the art has yet to be described in the ful management of metatarsal fractures.