Forum - Questions & Answers

Oct 20th, 2016 - Lion21 1 

Patellar fracture

I'm struggling to find the right code for this procdure. Would you code a hemipatellecomy 27350 which the quad repair is bundled into or take it to an ORIF 27524 but no internal fixation was used only sutures? Any suggestions would be helpful. Thanks in advance!

Diagnosis: Comminuted patellar fracture

Procedure Performed: Excision of multiple bony fragments with repair of quadriceps mechanism.

We made an approximately 6-inch midline skin incision over the patella and entered the fracture site and were very disappointed. The fracture was completely more comminuted than anticipated based on her plain films. The superior 2/3 of the patella was in no less than 10 parts and it was clearly not reconstructible. At this point, we elected to excise the superior 2/3 of the patella and then we placed 2 large Ethibond sutures in a Bunnell-type stitch fashion through the quadriceps. We then drilled 3 longitudinal channels in the remnant of the patella and placed the sutures through those and tied the sutures tightly over the inferior aspect of the patella. We then oversewed with multiple stitches of interrupted #1 Vicryl and interrupted 0 Vicryl. We then irrigated thoroughly and removed the knee and did feel that the quadriceps mechanism was intact.



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