The patient failed conservative care and desires to have the surgical correction at this time. This is a female admitted to hospital for elective surgery consisting of the above mentioned procedures due to persistent pain. Excision cuboid fracture with interpositional arthroplasty 4th and 5th TMT JĤ. Repair and reattachment of peroneus brevis tendon leftģ. Open reduction, internal fixation 5th metatarsal base fracture left footĢ. The multiple drill holes to the 4th and 5th metatarsal base and remaining cuboid we then sutured the graft into place to allow for interpositional arthroplasty.Ĭlick to expand.This is the whole op note:ġ. Once smooth margins were obtained we then placed an arthro flex graft which was sutured together in an "accordion" type fashion. This portion of the cuboid was then completely excised due to its severe arthritic nature with no benefit to open reduction and internal fixation. There is significant comminution to the distal aspect of the cuboid secondary to prolonged nail union in fracture to the 5th metatarsal base causing significant arthritis. We then inserted the Arthrex 3.5 mm anchor into the bone and reattached the peroneus brevis tendon with multiple stitches as well as 1 running stitch. Screws were then placed according manufacture guidelines. This was confirmed clinically and with C-arm fluoroscopy. A lateral locking plate was placed along 5th metatarsal base. We then bluntly dissected down to level of bone to identify the peroneus brevis attachment which was then reflected to allow for placement of the hardware. Incision was made down to epidermis and dermis with care protect neurovascular structures in the area. Excision cuboid fracture with interpositional arthroplasty 4th and 5th TMT J - code ?Īttention was directed to 5th metatarsal base where a longitudinal linear incision was made overlying the metatarsal base and proximal to expose the peroneus brevis tendon. Repair and reattachment of peroneus brevis tendon left - code 28200ģ. Open reduction, internal fixation 5th metatarsal base fracture left foot - code 28485Ģ. Hoping someone can help me with the coding for the interpositional arthroplasty of the 4th and 5th TMTJ.ġ. Type II: nonweight-bearing immobilization vs.I am stuck on a surgery. 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. Type I fractures are generally treated conservatively with a nonweight-bearing short leg cast for six to eight weeks. 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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