Splinting, Casting, Wrapping and Taping Faculty Disclosure
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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. -
ICD-10 Diagnoses on Router
L ARTHRITIS R L HAND R L ANKLE R L FRACTURES R OSTEOARTHRITIS: PRIMARY, 2°, POST TRAUMA, POST _____ CONTUSION ACHILLES TEN DYSFUNCTION/TENDINITIS/RUPTURE FLXR TEN CLAVICLE: STERNAL END, SHAFT, ACROMIAL END CRYSTALLINE ARTHRITIS: GOUT: IDIOPATHIC, LEAD, CRUSH INJURY AMPUTATION TRAUMATIC LEVEL SCAPULA: ACROMION, BODY, CORACOID, GLENOID DRUG, RENAL, OTHER DUPUYTREN’S CONTUSION PROXIMAL HUMERUS: SURGICAL NECK 2 PART 3 PART 4 PART CRYSTALLINE ARTHRITIS: PSEUDOGOUT: HYDROXY LACERATION: DESCRIBE STRUCTURE CRUSH INJURY PROXIMAL HUMERUS: GREATER TUBEROSITY, LESSER TUBEROSITY DEP DIS, CHONDROCALCINOSIS LIGAMENT DISORDERS EFFUSION HUMERAL SHAFT INFLAMMATORY: RA: SEROPOSITIVE, SERONEGATIVE, JUVENILE OSTEOARTHRITIS PRIMARY/SECONDARY TYPE _____ LOOSE BODY HUMERUS DISTAL: SUPRACONDYLAR INTERCONDYLAR REACTIVE: SECONDARY TO: INFECTION ELSEWHERE, EXTENSION OR NONE INTESTINAL BYPASS, POST DYSENTERIC, POST IMMUNIZATION PAIN OCD TALUS HUMERUS DISTAL: TRANSCONDYLAR NEUROPATHIC CHARCOT SPRAIN HAND: JOINT? OSTEOARTHRITIS PRIMARY/SECONDARY TYPE _____ HUMERUS DISTAL: EPICONDYLE LATERAL OR MEDIAL AVULSION INFECT: PYOGENIC: STAPH, STREP, PNEUMO, OTHER BACT TENDON RUPTURES: EXTENSOR OR FLEXOR PAIN HUMERUS DISTAL: CONDYLE MEDIAL OR LATERAL INFECTIOUS: NONPYOGENIC: LYME, GONOCOCCAL, TB TENOSYNOVITIS SPRAIN, ANKLE, CALCANEOFIBULAR ELBOW: RADIUS: HEAD NECK OSTEONECROSIS: IDIOPATHIC, DRUG INDUCED, SPRAIN, ANKLE, DELTOID POST TRAUMATIC, OTHER CAUSE SPRAIN, ANKLE, TIB-FIB LIGAMENT (HIGH ANKLE) ELBOW: OLECRANON WITH OR WITHOUT INTRA ARTICULAR EXTENSION SUBLUXATION OF ANKLE, -
6.3.3 Distal Radius and Wrist
6 Specific fractures 6.3 Forearm and hand 6.3.3 Distal radius and wrist 1 Assessment 657 1.1 Biomechanics 657 1.2 Pathomechanics and classification 657 1.3 Imaging 658 1.4 Associated lesions 659 1.5 Decision making 659 2 Surgical anatomy 660 2.1 Anatomy 660 2.2 Radiographic anatomy 660 2.3 Preoperative planning 661 2.4 Surgical approaches 662 2.4.1 Dorsal approach 2.4.2 Palmar approach 3 Management and surgical treatment 665 3.1 Type A—extraarticular fractures 665 3.2 Type B—partial articular fractures 667 3.3 Type C—complete articular fractures 668 3.4 Ulnar column lesions 672 3.4.1 Ulnar styloid fractures 3.4.2 Ulnar head, neck, and distal shaft fractures 3.5 Postoperative care 674 3.6 Complications 676 3.7 Results 676 4 Bibliography 677 5 Acknowledgment 677 656 PFxM2_Section_6_I.indb 656 9/19/11 2:45:49 PM Authors Daniel A Rikli, Doug A Campbell 6.3.3 Distal radius and wrist of this stable pivot. The TFCC allows independent flexion/ 1 Assessment extension, radial/ulnar deviation, and pronation/supination of the wrist. It therefore plays a crucial role in the stability of 1.1 Biomechanics the carpus and forearm. Significant forces are transmitted across the ulnar column, especially while making a tight fist. The three-column concept (Fig 6.3.3-1) [1] is a helpful bio- mechanical model for understanding the pathomechanics of 1.2 Pathomechanics and classification wrist fractures. The radial column includes the radial styloid and scaphoid fossa, the intermediate column consists of the Virtually all types of distal radial fractures, with the exception lunate fossa and sigmoid notch (distal radioulnar joint, DRUJ), of dorsal rim avulsion fractures, can be produced by hyper- and the ulnar column comprises the distal ulna (DRUJ) with extension forces [2]. -
Upper Extremity
Upper Extremity Shoulder Elbow Wrist/Hand Diagnosis Left Right Diagnosis Left Right Diagnosis Left Right Adhesive capsulitis M75.02 M75.01 Anterior dislocation of radial head S53.015 [7] S53.014 [7] Boutonniere deformity of fingers M20.022 M20.021 Anterior dislocation of humerus S43.015 [7] S43.014 [7] Anterior dislocation of ulnohumeral joint S53.115 [7] S53.114 [7] Carpal Tunnel Syndrome, upper limb G56.02 G56.01 Anterior dislocation of SC joint S43.215 [7] S43.214 [7] Anterior subluxation of radial head S53.012 [7] S53.011 [7] DeQuervain tenosynovitis M65.42 M65.41 Anterior subluxation of humerus S43.012 [7] S43.011 [7] Anterior subluxation of ulnohumeral joint S53.112 [7] S53.111 [7] Dislocation of MCP joint IF S63.261 [7] S63.260 [7] Anterior subluxation of SC joint S43.212 [7] S43.211 [7] Contracture of muscle in forearm M62.432 M62.431 Dislocation of MCP joint of LF S63.267 [7] S63.266 [7] Bicipital tendinitis M75.22 M75.21 Contusion of elbow S50.02X [7] S50.01X [7] Dislocation of MCP joint of MF S63.263 [7] S63.262 [7] Bursitis M75.52 M75.51 Elbow, (recurrent) dislocation M24.422 M24.421 Dislocation of MCP joint of RF S63.265 [7] S63.264 [7] Calcific Tendinitis M75.32 M75.31 Lateral epicondylitis M77.12 M77.11 Dupuytrens M72.0 Contracture of muscle in shoulder M62.412 M62.411 Lesion of ulnar nerve, upper limb G56.22 G56.21 Mallet finger M20.012 M20.011 Contracture of muscle in upper arm M62.422 M62.421 Long head of bicep tendon strain S46.112 [7] S46.111 [7] Osteochondritis dissecans of wrist M93.232 M93.231 Primary, unilateral -
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. -
BSUH VFC Initial Management Guidelines Dec 2014
BSUH VFC initial management guidelines Dec 2014 Contents Page Elbow injuries: Radial head / Radial neck fractures 3 Elbow dislocations 3 Shoulder Injuries: Shoulder dislocation 4 ACJ dislocation 4 Proximal Humerus fractures 5 Greater Tuberosity fractures 5 Midshaft Humerus 6 Mid-shaft clavicle fractures 7 Lateral 1/3 Clavicle fractures 8 Medial 1/3 clavicle fractures 9 Soft tissue injury shoulder 11 Calcific tendinitis 11 Common lower limb injuries Foot injuries: 5th Metatarsal fracture 12 Stress fractures 12 5th Midshaft fractures 12 Single Metatarsal fractures 12 Single phalanx fractures 12 Multiple Metatarsal fractures 13 Mid-foot fractures 13 Calcaneal fractures 14 Ankle injuries: Page 1 of 18 Weber A ankle fractures 15 Weber B 15 Weber C 15 Medial malleolus / and Posterior malleolus fractures 15 Bi-tri malleolus fractures 16 Soft tissue ankle injury / Avulsion lateral malleolus 16 TA ruptures 16 Knee injuries Locked Knee 17 Soft tissue knee injury 17 Patella Dislocation 17 Patella fractures 17 Possible Tumours 18 Page 2 of 18 Upper Limb Injuries Elbow injuries Radial head / neck fractures Mason 1 head / borderline Mason 1-2 protocol BAS for comfort only 2/52 and early gentle ROM DC VFC. Patient to contact VFC at 3/52 post injury if struggling to regain ROM Mason 2 >2mm articular step off discuss case with consultant on hot week likely conservative management if unsure d/w upper limb consultants opinion for 2/52 repeat x-ray and review in VFC Mason 3 head # or >30degrees neck angulation = Urgent Ref to UL clinic (LL or LT) for discussion with regards to surgical management. -
2014 Newsletter – Winter
NEWS ISSUE 14 I WINTER 2014 Welcome to our Winter edition of Orthosports News Winter is the time when Alpine Injuries present themselves WHO ORTHOSPORTS – Dr Doron Sher covers the most common types of alpine ARE WE? LOCATIONS injuries. Dr Kwan Yeoh takes a look at Mallet Finger and Orthosports is > Concord 02 9744 2666 “Imaging of the knee” is covered by Dr Sher in our Key a professional > Hurstville 02 9580 6066 Examination Points Section. association of > Penrith 02 4721 7799 Many GPs have attended our Category 1 Education Modules; AOA Orthopaedic > Randwick 02 9399 5333 A USTRAL I A N ORTHOPA EDIC Surgeons based Or visit our website there are 4 remaining dates for our 2014 RACGP approved A S S O CIA T I O N modules. See page 4 for details. in Sydney. www.orthosports.com.au We hope you enjoy this issue – The Team at Orthosports elbow injuries and more comminuted clavicle fractures. Alpine Injuries Shoulder dislocation is also very common. Snowboarders do not usually injure their legs when both feet are attached Skiing and snowboarding are exhilarating sports. They to the board but injuries to the knee are not uncommon are physically demanding and require co-ordination, getting on and off lifts when only one foot is bound to the strength, fitness and lots of specialized equipment. More board (more common in beginners). If they do injure their people ski than snowboard and snowboarders are generally knee, it is almost always in a terrain park landing from younger than skiers. Skiing and snowboarding injuries a big jump. -
Treatment of Distal Radius Fractures – Clinical Outcome, Regional Variation and Health Economics
From THE DEPARTMENT OF CLINICAL SCIENCE AND EDUCATION, SÖDERSJUKHUSET Karolinska Institutet, Stockholm, Sweden TREATMENT OF DISTAL RADIUS FRACTURES – CLINICAL OUTCOME, REGIONAL VARIATION AND HEALTH ECONOMICS Jenny Saving Stockholm 2019 All previously published papers were reproduced with permission from the publisher. Published by Karolinska Institutet. Printed by Eprint AB 2019 © Jenny Saving, 2019 ISBN 978-91-7831-339-6 Treatment of distal radius fractures – clinical outcome, regional variation and health economics THESIS FOR DOCTORAL DEGREE (Ph.D.) By Jenny Saving, MD Principal Supervisor: Opponent: MD, Associate Professor Anders Enocson MD, Professor Lars Adolfsson Karolinska Institutet University of Linköping Department of Clinical Science and Education Department of Clinical and Experimental Division of Orthopaedics Medicine Södersjukhuset Examination Board: Co-supervisor(s): MD, Professor Hans Mallmin MD, PhD, Cecilia Mellstrand Navarro Uppsala University Karolinska Institutet Department of Surgical Sciences Department of Clinical Science and Education Section of Orthopaedics Division of Hand Surgery Södersjukhuset MD, Associate Professor Rüdiger Weiss Karolinska Institutet MD, Professor Sari Ponzer Department of Molecular Medicine and Surgery Karolinska Instiutet Karolinska University Hospital Department of Clinical Science and Education Division of Orthopaedics MD, Professor Olof Nilsson Södersjukhuset Uppsala University Department of Surgical Sciences Section of Orthopaedics To my family 3 4 ABSTRACT A distal radius fracture (DRF) remains the most common fracture encountered in health care. DRFs have traditionally been treated with a plaster or surgically with percutaneous methods. Since the end of the 20th century, when internal fixation with a volar locking plate (VLP) was introduced, the incidence of DRF surgery in general and of plating in particular have increased markedly. -
Metacarpal Fractures
METACARPAL FRACTURES BY LORYN P. WEINSTEIN, MD, AND DOUGLAS P. HANEL, MD The majority of metacarpal fractures are closed injuries amenable to conservative treatment with external immobilization and subsequent rehabilitation. Internal fixation is favored for unstable fracture patterns and patients who require early motion. Percutaneous pinning usually is successful for metacarpal neck fractures and comminuted head fractures. Shaft and base fractures can be treated with pinning or open reduction and internal fixation; the latter, being more rigid, allows early rehabilitation. External fixation has a limited yet defined role for metacarpal fractures with complex soft-tissue injury and/or segmental bone loss. The recent development of bioabsorbable implants holds promise for skeletal rigidity with minimal soft-tissue morbidity, but long-term in vivo data support- ing the use of these implants is not currently available. Copyright © 2002 by the American Society for Surgery of the Hand arly treatment of metacarpal fractures was lim- Surgical techniques rapidly expanded to include ret- ited to the only tools available: manipulation rograde fracture pinning, intramedullary pinning, and Eand casting. The discovery of percutaneous transfixion pinning. Many of the K-wires in use today fracture fixation near the turn of the century opened have the same diamond-shaped tip and sizing speci- up a new world of possibilities. It was 25 years after fications as the original design. Bennett’s original manuscript that Lambotte de- The first plate and screw set for the hand was scribed the first surgical stabilization of a basilar introduced in the late 1930s. By today’s standards, the thumb fracture by using a thin carpenter’s nail.1 By Hermann Metacarpal Bone Set was quite lean; it 1913, Lambotte had authored a fracture text with included 3 longitudinal plates of 2, 3, and 4 holes, a multiple examples of pinning, wiring, and plating of drill, screwdriver, and 9 screws.1 Improvements in hand fractures. -
Ankle Fractures
HughstonHughston HealthHealth AlertAlert 6262 Veterans Parkway, PO Box 9517, Columbus, GA 31908-9517 • www.hughston.com/hha FRACTURES AND YOU Volume 19, Number 2 - Spring 2007 Inside... Fig. 1. Normal anatomy of the ankle • Distal Radius Fractures • Wrist Fracture Therapy Posterior (back) view • Hip Fractures in Young Athletes • Protecting a Fracture Lateral (outside) view • Robert J. McAlindon, MD Tibia Fibula Ankle Fractures Posterior Tibia tibiofibular Fibula Ankle fractures often occur in ligament Anterior athletes who play in pivoting sports Talus tibiofibular ligament such as football, basketball, and soccer. Anterior However, simple movements while Posterior talofibular doing common, everyday activities can talofibular ligament ligament cause ankle fractures. Activities, such as stepping off a curb and turning your ankle, falling off your kitchen stool and twisting your ankle, and falling from a ladder and fracturing the ankle at Deltoid Calcaneus Calcaneofibular impact can cause mild to serious ankle ligament (heel bone) ligament fractures. The ankle is a ginglymus (hinge) joint that connects the foot and leg. If a fracture, or bones and the strength of the ligaments provide excellent break, occurs in any of the 3 bones (tibia, fibula, and talus) joint stability. or if a combination of the 3 bones are cracked, or broken, One of the most important considerations when dealing the injury is considered an ankle fracture. An ankle with ankle fractures is the articular cartilage (covering on fracture can be painful and it can keep you from doing the the ends of bones), or gristle caps. The articular cartilage in things you enjoy, so prompt diagnosis and treatment is the ankle can withstand multiple times a body’s weight necessary. -
Hughston Health Alert US POSTAGE PAID the Hughston Foundation, Inc
HughstonHughston HealthHealth AlertAlert 6262 Veterans Parkway, PO Box 9517, Columbus, GA 31908-9517 • www.hughston.com/hha VOLUME 26, NUMBER 4 - FALL 2014 Fig. 1. Knee Inside... anatomy and • Rotator Cuff Disease ACL injury. Extended (straight) knee • Bunions and Lesser Toe Deformities Femur • Tendon Injuries of the Hand (thighbone) Patella In Perspective: (kneecap) Anterior Cruciate Ligament Tears Medial In 1992, Dr. Jack C. Hughston (1917-2004), one of the meniscus world’s most respected authorities on knee ligament surgery, MCL LCL shared some of his thoughts regarding injuries to the ACL. (medial “You tore your anterior cruciate ligament.” On hearing (lateral collateral collateral your physician speak those words, you are filled with a sense ligament) of dread. You envision the end of your athletic life, even ligament) recreational sports. Today, a torn ACL (Fig. 1) has almost become a household Tibia word. Through friends, newspapers, television, sports Fibula (shinbone) magazines, and even our physicians, we are inundated with the hype that the knee joint will deteriorate and become arthritic if the ACL is not operated on as soon as possible. You have been convinced that to save your knee you must Flexed (bent) knee have an operation immediately to repair the ligament. Your surgery is scheduled for the following day. You are scared. Patella But there is an old truism in orthopaedic surgery that says, (kneecap) “no knee is so bad that it can’t be made worse by operating Articular Torn ACL on it.” cartilage (anterior For many years, torn ACLs were treated as an emergency PCL cruciate and were operated on immediately, even before the initial (posterior ligament) pain and swelling of the injury subsided. -
Pediatric Ankle Fractures
CHAPTER 26 PEDIATRIC ANKLE FRACTURES Sofi e Pinney, DPM, MS INTRODUCTION stronger than both the physis and bone. As a result, there is a greater capacity for plastic deformation and less chance of The purpose of this review is to examine the current intra-articular fractures, joint dislocation, and ligamentous literature on pediatric ankle fractures. I will discuss the disruptions. However, ligamentous injury may be more anatomic considerations of a pediatric patient, how to common than originally believed (1). A case-control study evaluate and manage these fractures, and when to surgically by Zonfrillo et al found an association between an increased repair them. Surgical techniques and complications will be risk of athletic injury in obese children, and concluded a briefl y reviewed. higher body mass index risk factor for ankle sprains (4). Ankle fractures are the third most common fractures in Secondary ossifi cation centers are located in the children, after the fi nger and distal radial physeal fracture. epiphysis. The distal tibial ossifi cation center appears at 6-24 Approximately 20-30% of all pediatric fractures are ankle months of age and closes asymmetrically over an 18-month fractures. Most ankle fractures occur at 8-15 years old. The period fi rst central, then medial and posterior, with the peak injury age is 11-12 years, and is relatively uncommon anterolateral portion closing last at 15 and 17 years of age for under the age 5. This injury is more common in boys. females and males, respectively. The distal fi bula ossifi cation The most common cause of pediatric ankle fractures is a center appears at 9-24 months of age and closes 1-2 years rotational force, and is often seen in sports injuries associated after the distal tibial.