Vignettes are reviewed annually and updated when necessary. The AO classification is an expansion of the Danis-Weber system. View historical information about the code including when it was added, changed, deleted, etc. These variables affect wound healing, as well as the healing of the fracture itself. A detailed analysis of fracture types and surgical management is beyond the scope of this book. Cast immobilization typically is effective for management, and bony remodeling usually compensates for any minor malalignments. This has significant implications for development of tibiotalar joint arthritis. 23-14). This chapter focuses on supination external rotation bimalleolar ankle fractures, an injury pattern that accounts for up to 75% of ankle fractures. Subscribers will be able to see codes in a code-book page-like view here. Ankle fractures can be treated conservatively if the ankle mortise remains stable. When this protocol was used, the major complication rate was 25% with 13% progressing to amputation. It is important that the patient be compliant because frequently the patients are placed in a removable cast boot. Evaluation of radiographs should focus on ankle instability. Thank you for choosing Find-A-Code, please Sign In to remove ads. Every vignette contains a Clinical Example/Typical Patient and a description of Procedure/Intra-service. In general, ORIF should be performed on all patients, regardless of age, gender, activity level, or vocation, as long as they are healthy enough to undergo the procedure. Once stability is ensured, motion may be introduced; however, weight bearing should be withheld for 6 to 8 weeks until healing is confirmed. 5-14). Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. View calculated CPT fee values specifically for your Medicare locality. The following specific injuries are indications for conservative treatment: isolated nondisplaced medial malleolar fracture or tip avulsion fracture, isolated lateral malleolar fracture with less than 3 mm displacement and no talar shift, and a posterior malleolar fracture with less than 25% joint involvement or less than 2-mm stepoff. A thorough history and physical examination must be obtained. Doctors classify ankle fractures according to the area of bone that is broken. CPT code information is copyright by the AMA. Special attention must also be given to diagnosing associated injuries and fractures. If you work with several fee schedules or would like to create custom fee comparison reports, you need our exclusive Compare-A-Fee™ tool. These typically occur in the 12- to 14-year age range as the medial tibial physis begins to close, creating an irregular stress distribution and resistance to forces applied across the ankle (Fig. William C. McGarvey, in Baxter's the Foot and Ankle in Sport (Second Edition), 2008. The most common mechanism of an ankle fracture is from forced external rotation with the ankle held fixed in supination (supination-external rotation). ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. 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JOHNSON, ANDREW BRIAN THOMSON, in, Levin and O'Neal's The Diabetic Foot (Seventh Edition), Fractures and Dislocations of the Foot and Ankle, Orthopaedic Physical Therapy Secrets (Third Edition), Open Reduction Internal Fixation Bimalleolar Ankle Fracture, Open Reduction and Internal Fixation of the Ankle, Rehabilitation for the Postsurgical Orthopedic Patient (Third Edition), Open Reduction and Internal Fixation of Ankle Fractures, Gowned and Gloved Orthopaedics: Introduction to Common Procedures, James T. Reagan MD, ... John J. Jasko MD, in, Clinical Orthopaedic Rehabilitation: a Team Approach (Fourth Edition), Ankle and Midfoot Fractures and Dislocations, Baxter's the Foot and Ankle in Sport (Second Edition), Alvin H. Crawford, ... Shital N. Parikh, in, Green's Skeletal Trauma in Children (Fifth Edition), Appendix for Chapter 20: Lower Leg, Ankle, and Foot Rehabilitation, Edward P. 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