Help coding fracture/laceration repair

26735-F4
and? Need some guidance on this one please, still learning surgeries.

tia
M,CCS,CPC

PREOPERATIVE DIAGNOSES:

1. Complex open wound Left 4th web space

2. Displaced Left 5th Prox phalanx fracture

POSTOPERATIVE DIAGNOSES:

1. Complex open wound Left 4th web space

2. Displaced Open Left 5th Prox phalanx fracture

3. Open left 5th MCP joint

4. Interosseous tendon laceration

OPERATIONS PERFORMED:

1. Wound exploration / Irrigation & Debridement of left 4th web /ring finger complex wound (6 cm), open 5th P1 base intra-articular fracture and open 5th MCP joint.

2. Open reduction / Internal fixation left 5th Proximal phalanx base fracture

3. Left 5th palmar interosseous tendon repair

4. Delayed primary closure left 6 cm hand complex wound

TOURNIQUET TIME:

34 mins.

ESTIMATED BLOOD LOSS:

minimal.

FLUIDS:

Per anesthesia record.

OPERATIVE FINDINGS:

1. 6 cm complex left hand ulno-dorsal ring to 4th web laceration with inverted web space wound margins, moderate maceration. NO infection. Moderate amount devitalized tissue.

2. Open 5th P1 base IA moderately comminuted RCL avulsion fx and open 5th MCP joint

3. Intact 5th RDN in wound.

OPERATIVE SUMMARY IN DETAIL:

Following appropriate informed consent, patient identification, and operative limb, the patient was brought to the operating suite where smooth induction of LMA anesthesia was accomplished by the anesthesiology service. Broad spectrum IV antibiotic prophylaxis was given. The left upper extremity was prepped and draped in the usually fashion and a time out was performed identifying patient, limb(s) and procedure(s). The fracture was then exposed using an ellipsing incision over the fracture site, excising the traumatic partially healed wound. Inverted deep web space skin margins were present and a 1.5 -2 cm portion of the wound was not healed. The 2 cm over the ulnar ring was healed bur offest. The entire traumatic wound was excised marginally 1-2 mm. NO infection and a moderate amount of fat necrosis/devitalized tissue was present and excised. I&D was performed serially with debridements untip a tidy wound was produced. The depths of the wound and IA P1 5th base avulsion fx and open 5th MCP joints were appreciated and debrided. The comminuted avulsion fx was unstable and allowing the 5th MCp to sublux ulnarly. The fracture was exposed using meticulous dissection and mobilization of nerves/vessels/tendons and full thickness flaps were elevated. Purulence was not present. Thorough debridement was preformed in multiple rounds until a tidy surgical wound was produced There was significant comminution. Internal fixation was necessitated and fixation/stabilization with an intra-osseous mini Mitek anchor was performed with predrilling through the larger fragment. Anatomic alignment was noted clinically and using fluoroscopy. Reduction and hardware placement was satisfactory. Additional sutures were used to reinforce the RCL repair and the palmar interosseous tendon was repaired back to the extensor hood The tourniquet was let down and hemostasis performed. Delayed primary cllosure was performed. Marcaine was used to infiltrate about the wound margins, periosteum and local peripheral nerves for perioperative pain relief. A sterile non adherent dressing was applied. A buddy dressing was applied to the 4th web space and 3-5 digits and the patient was extubated and transferred to the recovery area with a warm, viable hand and digits times five. There were no intraoperative complications and the patient tolerated the procedure well.

Help coding fracture/laceration repair