![]() Because the fracture is also fixed by the dislocation fixation, separate reporting may not be indicated. Percutaneous fixation of left tarsometatarsal dislocation with associated fracture at the base of the 2nd left metatarsal (it can be any one of five metatarsals) that is also stabilized by the percutaneous fixation of the dislocation: CPT code 28606 would be reported, per joint. Owing to a vascular watershed, zone II and III fifth metatarsal base fractures commonly progress to nonunion without operative intervention.Modifier T, per CPT, would not be appropriate for these metatarsal shaft fractures. CPT code 28485-59 would be reported three times to represent each metatarsal fracture, per CPT description of the code. CPT code 28615 would be reported for the fixation of the dislocation. ![]() The MT fractures are also treated by ORIF by separate incisions. Malunion of fracture (733.81) Nonunion of fracture (733.82) Radius / Ulna. Tarsometatarsal dislocation of the right midfoot along with mid-shaft fractures of the 2nd, 3rd and 4th MTs: The dislocation is treated by open reduction internal fixation (ORIF).The open reduction code is for each joint that is reduced in an open fashion. Lisfranc dislocation can be for one or many of the tarsometatarsal joints. Separately coding for the fixation of the metatarsal fractures could depend on the location of those fractures. Many times, both the dislocation and the fracture are treated separately with stabilization devices, which can be closed, percutaneous or open. The mechanism of the injury causes the tarsal bones to dislocate with or without resulting metatarsal (MT) fractures. (Lisfranc was a surgeon in Napoleon's army thus, the name is based on his description of the injury suffered by a soldier who fell off a horse with his foot trapped in the stirrup.) This injury can be caused by a high-energy blow to the foot or by a twisting fall. This type of injury can be consistent with a fracture accompanied by dislocation of the tarsometatarsal (Lisfranc) joint located in the middle of the foot. Type II: nonweight-bearing immobilization vs.I wanted to put this in for future reference when I look this up again, just in case, I found this through Margie Scully-Vaught. Type I: nonweight-bearing immobilization for six to eight weeks (may require up to 20 weeks) Stress fracture of the proximal metatarsal within 1.5 cm of tuberosity Types II, III: variable healing potential surgical fixation for active athletes or patients preferring surgical therapy Type II: nonweight-bearing immobilization vs. Type I: nonweight-bearing immobilization for six to eight weeks Laterally directed force on forefoot with ankle in plantar flexion Although most fractures of the proximal portion of the fifth metatarsal respond well to appropriate management, delayed union, muscle atrophy and chronic pain may be long-term complications.Īcute fracture of the proximal metatarsal within 1.5 cm of tuberosity (Jones fracture) All displaced fractures and type III fractures should be managed surgically. Type II fractures may also be treated conservatively or may be managed surgically, depending on patient preference and other factors. S92.011A Displaced fracture of body of right calcaneus initial encounter for closed fracture. M25.572 - Pain in left ankle and joints of left foot. Type I fractures are generally treated conservatively with a nonweight-bearing short leg cast for six to eight weeks. M25.571 - Pain in right ankle and joints of right foot. Management and prognosis of both acute (Jones fracture) and stress fracture of the fifth metatarsal within 1.5 cm of the tuberosity depend on the type of fracture, based on Torg's classification. Nondisplaced tuberosity fractures are usually treated conservatively, but orthopedic referral is indicated for fractures that are comminuted or displaced, fractures that involve more than 30 percent of the cubo-metatarsal articulation surface and fractures with delayed union. Local bruising, swelling and other injuries may be present. Tuberosity avulsion fractures cause pain and tenderness at the base of the fifth metatarsal and follow forced inversion during plantar flexion of the foot and ankle. Fractures of the proximal portion of the fifth metatarsal may be classified as avulsions of the tuberosity or fractures of the shaft within 1.5 cm of the tuberosity.
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