Operative Note 4: Internal Fixation of Clavicle Fracture

Home , Clavicle fracture, Scaphoid fracture

Orthopedic Operative2011 Orthopedic Note Coder, Operative Volume Note 1: Upper Coder, Extremities Volume 1

Operative Note 4: Internal fixation of clavicle fracture

Preoperative diagnosis Right type 2b distal clavicle fracture with coracoclavicular ligament disruption

Postoperative diagnosis Right type 2b distal clavicle fracture with coracoclavicular ligament disruption

Operative procedure Open reduction, internal fixation of right distal clavicle fracture with reconstruction of coracoclavicular ligaments

Description of procedure Patient was taken to the operating room, where general anesthesia was achieved. Patients right shoulder was sterilely prepped and draped in the usual fashion. A curvilinear incision distal to the clavicle was performed. This was carried out sharply to the subcutaneous tissue using Bovie electrocautery, coagulating bleeding vessels. Care was take to avoid damaging the overlying skin nerves. The distal fragment remained attached to the AC joint and was only approximately cm in size. The coracoclavicular ligaments were avulsed from their insertion points on the clavicle, but appeared to be well intact to the periosteal sheath. The fractures were debrided of any interposed tissue and the clavicle fracture was reduced. The coracoclavicular ligaments were repaired and reinforced with a total construct placed from proximal to distal, achieving an excellent stability in place of the coracoclavicular ligaments. The distal clavicle fracture itself was pinned with multiple 2 mm bioabsorbable K-wires. The periosteal sheath was then imbricated over the top of the clavicle with multiple sutures of 0 Vicryl. The subcutaneous tissue was closed with 2-0 Vicryl, the skin was closed with a

running subcuticular 4-0 Vicryl, and Mastiosol and Steri-Strips and the wound was instilled Operative Note 4 with 0.5% ropivacaine.

Code the case Report CPT® and ICD-9 codes as appropriate:

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Operative Note 17: Open reduction and internal fixation, wrist fracture

Preoperative diagnosis Left Scaphoid fracture

Postoperative diagnosis Left Scaphoid fracture

Operative procedure Open reduction and internal fixation, left scaphoid

Indications Brandon sustained a comminuted scaphoid waist fracture. The risks and benefits of cast treatment versus screw placement were discussed, and we elected to proceed with a screw placement.

Description of procedure The patient was given an axillary block and taken into the operating room. General anesthesia was induced and the left arm was prepped and draped. A tourniquet was inflated onto the left upper arm. A dorsal incision was made overlying Lister tubercle. The EPl tendon was identified and protected. A small needle was used

to radiographically locate the entry point for a scaphoid guidewire. An Acutrack Operative Note 17 mini guidewire was then placed across the scaphoid. Multiple attempts were made to be sure that the guidewire was central on both the AP and lateral views. Once the central location was confirmed, a drill was placed over the guidewire and the proximal aspect of the scaphoid was opened with a drill. A size 20 mini Acutrack screw was then advanced over the guidewire. C-arm images were used to confirm that the screw was completely confined within the bone on all views. The fracture line itself showed evidence on compression. The guidewire was then removed. The wounds were irrigated. The tourniquet was deflated. Bleeders were cauterized using bipolar electrocautery and the skin was closed with interrupted nylon sutures. A sterile dressing and a thumb spica splint were placed. The patient tolerated the procedure well. Postoperatively, he will return at 10 days’ time to go into a cast for initial four weeks postoperatively.