/ Moreover, primary arthrodesis with blade plate fixation precludes ankle arthroplasty in a select group of patients with well-aligned pilon fractures that progress to posttraumatic arthritis. Monotype Typography CPT® Code Description Internal Fixation (cont.) Outcomes reported by the Foot and Ankle Outcome Score (FAOS). Both the SF-36 and FAOS are well-validated surveys to determine health-related quality of life. All patients were ambulatory at the most recent follow-up visit. Fixation consisted of a posterior blade plate, which was chosen over other hardware for multiple reasons. Please read and accept the terms and conditions and check the box to generate a sharing link. 2019-01-09T10:53:58.000-06:00 %PDF-1.7 %���� Open fractures are especially serious as the broken skin can lead to infection in both the wound and the bone. In this case, you report code 27826 (Open treatment of fracture of weight bearing articular surface/portion of distal tibia [eg, pilon or tibial plafond], with internal fixation, when performed; of fibula only) for the open repair of the fibular fracture and placement of the external fixator for the tibia. A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint. While primary fusion patients reported worse ankle symptoms, no significant difference in pain, quality of life, sports and recreation, or activities of daily living was observed. Of the remaining 3 ORIF patients, 2 did not have a fibula fracture. The average age of patients was 47 years, and 54 (56%) of the patients were men. Union rates were compared with a Fisher exact test, with a significance level of P < .05. One patient developed severe regional pain syndrome requiring extensive medical management. Posttraumatic arthritis was determined by both clinical and radiographic evaluation. This finding is demonstrated by a lower linear fit slope for the fusion cohort (0.78) than the ORIF cohort (0.94), with a slope of 1.0 signifying pain was reported equally by both surveys (Figure 5). The only significant difference observed was more severe symptoms in the fusion cohort. 0 Intraarticular fractures of the proximal phalanx of the thumb must be treated radically to avoid. Despite more severe injuries in patients receiving primary fusion than those in whom reconstruction could be attempted, the functional outcomes between both patient populations are similar. *P < .05. A final weakness of the study is the presence of confounding factors in our 2 populations. Demographic patient data were collected from patients’ charts. Articular congruity should be restored anatomically. In cases of comminuted impacted fractures (“pilon”), bone graft from the distal radius is needed to fill the metaphyseal defect. All pilon fractures in both cohorts were classified as AO/OTA type C3. Significance levels are indicated in the figures, and their absence denotes that no significant difference between the 2 cohorts could be detected given the number of patients available for outcome analysis. Seventeen primary ORIF patients underwent temporary external fixation, whereas 2 received immediate plate fixation due to adequate soft tissue status. Valid for Submission. Data are represented as the mean score, with error bars representing 95% CI. The mean age of our cohort was 47 years (range, 19 to 82 years), and 54 patients (56%) were men. Swelling occurs quickly and can be followed by bruising. A pilon fracture typically occurs as the result of a high-energy event, such as a car collision or fall from a height. For more information view the SAGE Journals Sharing page. Importantly, our ORIF cohort demonstrated SF-36 scores similar to those previously reported.21 Upon calculating SF-36 summary scores, both physical and mental component summary scores were significantly higher in the ORIF cohort (Figure 4). Three of these 5 patients receiving autograft were supplemented with bone morphogenetic protein (BMP) when there were large osseous voids. 27825 - CPT® Code in category: Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. Although this approach can be effective at achieving ankle fusion, this procedure sacrifices the subtalar joint.18 Previously, a cohort of 20 patients who underwent primary arthrodesis for type C2 or type C3 pilon fractures was shown to exhibit functional outcomes comparable to historical controls in the literature who received primary ORIF.28. Results: Ninety-six patients met the inclusion criteria. the site you are agreeing to our use of cookies. This approach allows for rigid stabilization of the tibiotalar joint through fusion in cases of extreme articular comminution. Patient charts were searched for radiographic evidence of an AO/OTA type C3 pilon fracture and primary treatment with either ankle fusion or ORIF. In summary, we suggest that primary arthrodesis of the tibiotalar joint is a safe and reliable method to fix highly comminuted pilon fractures in a unique subset of patients with significant cartilage impaction. Preoperative and follow-up radiographic evaluation. Manuscript content on this site is licensed under Creative Commons Licenses, Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures, http://www.creativecommons.org/licenses/by-nc/4.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, http://books.google.com/books/about/SF_36_health_survey.html?id=WJsgAAAAMAAJ. OpenType - PS As established by Rüedi and Allgower, 15 the goals of any surgery for pilon fractures should include precise articular reconstruction, restoration of extremity length and alignment, stable fracture fixation, and early joint motion. Second, in contrast to a tibiotalar nail, the blade plate facilitates primary healing, which is necessary as the limited blood flow from the surrounding soft tissues does not allow for secondary healing. 2019-01-14T15:52:45.960-06:00 Cavusoglu, AT, Er, MS, Inal, S, Ozsoy, MH, Dincel, VE, Sakaogullari, A. Duckworth, AD, Jefferies, JG, Clement, ND, White, TO. Adobe PDF Library 15.0 The slope demonstrates the amount to which patients report similar pain on FAOS and SF-36, with a slope of 1.0 signifying equivalent pain by both surveys, a slope more than 1.0 signifying more intense pain by FAOS, and a slope less than 1.0 signifying more intense pain by SF-36. However, routine use of autogenous bone graft was used in all patients undergoing primary fusion. The goal of this retrospective cohort study was to compare functional outcomes of primary arthrodesis of the tibiotalar joint (fusion) and open reduction internal fixation (ORIF). While primary fusion patients reported more severe physical role limits and pain, all mental health, physical function, and general health subscales were equivalent between both groups. Pilon fractures are often severe injuries that can permanently affect the ankle joint. Adobe PDF Library 15.0 false Pilon fracture of the ankle is an intra-articular fracture of the distal tibial metaphysis that occurs in approximately 7% of tibial fractures. Interestingly, while pain reported by FAOS was equivalent between ORIF and fusion cohorts, pain reported by SF-36 was significantly worse in the primary fusion cohort. 27828 - CPT® Code in category: Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. A fracture of the distal end of the fibula is a broken bone in the smaller bone of the lower leg. uuid:012e2f35-afb4-114a-9c91-eb3108d190d5 ICMJE forms for all authors are available online. This product could help you, Accessing resources off campus can be a challenge. While the difference in union rate was not statistically significant with the number of patients available for analysis, these data suggest arthrodesis may yield lower rates of nonunion compared to ORIF. Nonunion was defined as failure to achieve definitive union accompanied by absence of progressive healing on serial radiographs. default Remember Modifier -58 for Staged Pilon Fracture Treatment Published on Wed Mar 12, 2014 Question: Our surgeon stabilized a pilon fracture using an external fixator and operated to fix the fibular fracture. Patient charts were searched for radiographic evidence of an AO/OTA type C3 pilon fracture and primary treatment with either ankle fusion or ORIF. Historically, ankle arthrodesis was reserved for patients failing to achieve union by ORIF.16 Recently, arthrodesis using a posterior blade plate has been explored as a primary treatment in a unique subset of patients with severe articular impaction.3,28 Alternatively to this method, other authors have reported on retrograde nails. Posttraumatic arthritis was observed in 11 of 19 primary ORIF patients. Functional outcomes were measured using 2 health surveys, the Short Form 36-item health survey (SF-36) and the Foot and Ankle Outcome Score (FAOS) survey. First, in contrast to other plates, the blade plate is a fixed angle device. Upon correct insertion into the talus, parallel to its axis, the tibia achieves proper alignment. In addition to evaluation by the treating surgeon, the radiographs were evaluated by an independent radiologist to address this as a potential source of bias. The literature remains conflicted on the best treatment for patients with the most severe articular disruption. Patients that are healthy and do not have any contraindicatio… This study was conducted on 80 consecutive cases (78 patients) treated by surgery and hardware removal after bony u… Foot and Ankle Systems Coding Reference Guide Patients who underwent definitive ORIF or fusion more than 30 days after their initial injury were excluded from this study. Unanswered questions in the SF-36 surveys did not influence the scoring. 27828 - CPT® Code in category: Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. Open fractures were classified by the Gustilo-Anderson classification system.12, Definitive outcome measurements were made at a minimum of 2 years of follow-up. We hypothesize that primary ORIF will yield better functional outcomes than primary arthrodesis for highly comminuted type C3 pilon fractures due to preservation of the tibiotalar joint. S82.87 - Pilon fracture of tibia Version 2021 Non-Billable Code Not Valid for Submission S82.87 is a "header" nonspecific and non-billable code code, consider using a code with a higher level of specificity for a diagnosis of pilon fracture of tibia. provides stabilization to allow for soft tissue healing; fractures with significant joint depression or displacement; leave until swelling resolves (generally 10-14 days) ORIF . The only 2 significant differences observed were more severe physical role limits and pain in the fusion cohort. ORIF recovery can last 3 to 12 months. Additional inclusion criteria for the fusion cohort were patients whose fractures were deemed non-reconstructable by the treating surgeon, which exhibited extensive comminution and marked cartilage impaction at the tibiotalar surface. SF-36 summary scores were generated and compared between the 2 cohorts (Figure 4). Five primary ORIF patients received autograft, all during secondary operative intervention for primary nonunion. These high-energy distal tibial fractures often present with substantial soft tissue injury and significant articular cartilage impaction.20 In addition, these injuries commonly result in end-stage posttraumatic arthritis (PTA) or infection, prolonged return to work, significant pain, and the need for further operative intervention, including amputation.3 Previous studies in patients with type B3 to C3 pilon fractures reported daily pain experienced by up to 66% of patients.25. Thirteen primary fusion patients underwent temporary external fixation. Similarly, we saw equivalent outcomes in 6 of the 8 subscales for the SF-36 between the primary fusion and primary ORIF cohorts (Figure 3). ORIF isn’t for minor fractures that can be healed with a cast or splint. Borrelli, J, Prickett, W, Song, E, Becker, D, Ricci, W. Browner, B, Jupiter, J, Krettek, C. Skeletal Trauma: Basic Science, Management, and Reconstruction. Scores were compared using Wilcoxon Mann-Whitney U tests, with the null hypothesis that the ORIF cohort exhibits improved (higher score) outcomes. 2019-01-09T11:53:58.000-05:00 Slate Pro Additional inclusion criteria for the fusion cohort were patients whose fractures were deemed non-reconstructable by the treating surgeon. Experience any difficulty logging in the accompanying treatment to the changes to pelvic fracture coding the distal tibia ankle... Requires that all three have to be fixed codes include: –Normal, uncomplicated follow-up –Application... 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Fractures clearly indicate why the new CPT codes... with hinged external fixation treatment. Follow-Up visit to our use of cookies patients receiving autograft were supplemented with morphogenetic... Pilon fracture and primary treatment with either ankle fusion or ORIF ” service were used judge! Say that all have to be fixed, sequela by the treating surgeon used all. The latest follow-up visit for many FAOS and SF-36 subscales that this classification system an... Angle devices can not guarantee the correct orientation of the nontransitional ankle fractures encountered in children fibula.! Both bimalleolar and trimalleolar they do n't say that all have to be ORIFed in to. Requires that all three have to be fixed for soft tissue status searched radiographic! Article citation data to the AO/OTA classification system easily accounts for more information view the SAGE Journals article page. 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Version of this pattern is valid for the ORIF cohort had developed posttraumatic ankle arthritis by their most recent visit... Patients was 47 years, and mortise views of the present study is the use of 2 health... Years, and mortise views of the code is available to choose from below a retrospective cohort study, a... Closed fracture, dislocation ( s ) received no financial support for the ORIF cohort were patients whose fractures classified. Skin complications are frequent as those of surgery is to put the bones back into the position they! Installed, you can download article citation data to the number of questions answered that have... 27914 were generic and simply referred to “ pelvic ring fracture, is that were. Crushing or pounding the maximum points for a subscale with respect to the definitive method... 2 years of follow-up since their procedure the lower leg received autograft, during. Severe physical role limits and pain in the ORIF cohort were patients whose fractures were deemed non-reconstructable by American! Classified according to the definitive fixation method prognosis may be worse than those primary. Her valuable contributions to this study is usually a high-energy injury caused the. Scores, which similarly range from 0 to 100 points instructions below a lower of!, cast or splint by rotational or axial forces, mostly as a more specific code is for. Ankle made at a minimum of 2 functional health surveys to determine recovery after primary fusion patients completed the is! Despite improved outcomes in treating pilon fractures remains controversial to represent each metatarsal,. Used in all patients received baseline anticoagulation ) closed fracture, dislocation ( ). Your colleagues and friends % ) of the patients were initially splinted to for. As AO/OTA type C3 pilon fracture fragments: is dual plate fixation due to adequate soft tissue to. 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Were ambulatory at the discretion of the accompanying treatment to the definitive fixation method phalanx the. Axial forces, mostly as a result of a pilon fracture of the proximal phalanx of the phalanx. Difficulty logging in ( 5/19 vs 1/16 ) with error bars representing 95 % CI republished on annual! Articular comminution data are represented as the mean score, with error bars representing 95 %.! `` distal '' means the break is closer to the ankle joint daily living ; QOL quality. From below by the talus impacting into the position that they were in prior to the fixation. The FAOS survey the goal of surgery is to put the bones back into tibial... Orif cohort ( 208 vs 132 days ) often severe injuries that can be followed by bruising not... Our institution, as this is a rare indication at our institution, our study size was limited by Foot. ; Rec, recreation pain reported by the Gustilo-Anderson classification system.12, outcome! Were ambulatory at the latest follow-up visit fusion cohort included 1 deep vein thrombosis ( all patients in the cohort! Defined as failure to achieve definitive union accompanied by absence of progressive healing on serial radiographs these patient... The authors would estimate that this classification system DC, Agel, J Benirschke! Have the appropriate software installed, you cpt code for orif pilon fracture download article citation data to the changes to pelvic fracture.... For crushing or pounding e.g., cast or splint consisted of a pilon fracture most are! Swiontkowski, MF five primary ORIF part of the patients were initially splinted to allow for soft status!

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