Pilon fractures are often severe injuries that can permanently affect the ankle joint. Introduction . The higher rate of nonunion observed in the primary ORIF group suggests that primary fusion should be considered an effective procedure for severe injuries to decrease the need for further operative intervention. Patients who underwent primary ORIF or fusion for pilon fractures at our institution since 2000 were identified by Current Procedural Terminology (CPT) code. Patients who underwent definitive ORIF or fusion more than 30 days after their initial injury were excluded from this study. Despite improved outcomes in treating pilon fractures, management of severely comminuted type C3 pilon fractures remains challenging. Postoperative outcomes and hospital logistical data were compared between the two groups. Outcome assessment was determined by the Foot and Ankle Outcome Score (FAOS) and Short Form 36-item health survey (SF-36), time to radiographic union or fusion, and wound-healing complications at a minimum of 2 years after their surgery. Sequence of bone stabilization. CPT code 28615 would be reported for the fixation of the dislocation. Expert AAPC-certified coders in established medical coding companies keep track of these changes and report them correctly, enabling the orthopedic practices they serve to maximize reimbursement. xmp.did:0a8a9f0e-a373-4c07-9746-79c4ecc46d33 SF-36 and FAOS raw responses were converted to subscale scores on a scale of 0 to 100, with a score of 100 indicating the best possible outcome. Status: Production: Format: UMLS: Contact: American Medical Association, Intellectual.PropertyServices@ama-assn.org: Categories: Approval to conduct this study was received from our institutional review board. Emot, emotional; Funct, function; Gen, general; Phys, physical. Patients who have suffered a displaced Pilon (Tibial Plafond) fracture(Figure 1)often benefit from surgery to reposition the bones that make up the top part of the ankle joint (Figure 2). *P < .05. Similarly, we saw equivalent outcomes in 6 of the 8 subscales for the SF-36 between the primary fusion and primary ORIF cohorts (Figure 3). Thus we performed external fixation as treatment for these fractures. Nonunion was defined as failure to achieve definitive union accompanied by absence of progressive healing on serial radiographs. The most severe are classified by the AO/Orthopaedic Trauma Association (AO/OTA) as type C3 pilon fractures. Only code 27823 requires that ALL three have to be fixed. 27828 - CPT® Code in category: Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more. Nineteen primary ORIF patients and 16 primary fusion patients completed the SF-36 and FAOS forms. Results: Ninety-six patients met the inclusion criteria. Interestingly, while pain reported by FAOS was equivalent between ORIF and fusion cohorts, pain reported by SF-36 was significantly worse in the primary fusion cohort. Historically, ankle arthrodesis was reserved for patients failing to achieve union by ORIF.16 Recently, arthrodesis using a posterior blade plate has been explored as a primary treatment in a unique subset of patients with severe articular impaction.3,28 Alternatively to this method, other authors have reported on retrograde nails. The ankle joint involves the tibial-fibular mortise and talus. FAOS is used to determine foot- and ankle-specific capacity, whereas SF-36 is used to assess many health conditions, facilitating comparisons to other patient populations. Open: If the podiatrist performs open treatment, report CPT code 27792 (Open treatment of distal fibular fracture [lateral malleolus], includes internal fixation when performed). Inclusion criteria for the ORIF cohort were patients with an AO/OTA type C3 pilon fracture. Therapeutic Level III, retrospective cohort. Populations were compared using Wilcoxon Mann-Whitney rank sum to determine significant differences between scores for each category. Fixation consisted of a posterior blade plate, which was chosen over other hardware for multiple reasons. Comp, component; Phys, physical; Sum, summary. If the external fixator does not lock into extension, a static resting extension finger splint is fabricated, and the patient wears it at all times when not exercising. The mean age of our cohort was 47 years (range, 19 to 82 years), and 54 patients (56%) were men. OpenType - PS uuid:012e2f35-afb4-114a-9c91-eb3108d190d5 7 In contrast to our hypothesis, outcomes for primary ORIF and primary fusion were similar for many FAOS and SF-36 subscales. Due to the high incidence of PTA and pain that result from highly comminuted pilon fractures, we sought to explore arthrodesis as the primary treatment for a very unique subset of patients with significant articular comminution and impaction. The tibiotalar joint was packed with posterior iliac crest autograft for all fusion patients. 27422 - Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation Adobe PDF Library 15.0 Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. All pilon fractures in both cohorts were classified as AO/OTA type C3. SlatePro-Bold To determine whether patients report pain differently on the 2 surveys, we linearly correlated pain scores determined by SF-36 and FAOS (Figure 5). 2. OpenType - PS The only significant difference observed was more severe symptoms in the fusion cohort. Fracture pattern was classified according to the AO/OTA classification system. Populations were compared using Wilcoxon Mann-Whitney rank sum to determine significant differences between scores for each category. ICD-10-CM Codes › S00-T88 Injury, poisoning and certain other consequences of external causes ; S80-S89 Injuries to the knee and lower leg ; S82-Fracture of lower leg, including ankle 2021 ICD-10-CM Diagnosis Code S82.87 One nonunion in the ORIF cohort was complicated by a history of diabetes. Deleted codes 27193 and 27914 were generic and simply referred to “pelvic ring fracture, dislocation(s), diastasis or subluxation. Methods: Patients who underwent primary ORIF or fusion for pilon fractures at our institution since 2000 were identified by Current Procedural Terminology (CPT) code. application/pdf Parameters collected to assess postoperative recovery included time to union or ankle fusion, follow-up time, ambulation status, wound complications, presence of posttraumatic arthritis, and other operative complications. All patients in both cohorts adequately healed their operative wounds without evidence of infection or need for further operative intervention. Thirteen primary fusion patients underwent temporary external fixation. In cases of comminuted impacted fractures (“pilon”), bone graft from the distal radius is needed to fill the metaphyseal defect. Fibula or tibia first? Anteroposterior (A, C, E, G) and lateral (B, D, F, H) radiographs of type C3 pilon fractures upon presentation (A, B, E, F) or after 7 years of follow-up after primary open reduction internal fixation (C, D) or 6 years of follow-up after primary fusion (G, H). 0 Methods: Patients who underwent primary ORIF or fusion for pilon fractures at our institution since 2000 were identified by Current Procedural Terminology ( CPT ) code. Create a link to share a read only version of this article with your colleagues and friends. The operative management of severely comminuted tibial plafond fractures remains challenging. Outcomes reported by the Short Form 36-item health survey (SF-36). The authors would estimate that this classification system easily accounts for more than 90% of the nontransitional ankle fractures encountered in children. While primary fusion patients reported more severe physical role limits and pain, all mental health, physical function, and general health subscales were equivalent between both groups. Login failed. ICMJE forms for all authors are available online. Manuscript content on this site is licensed under Creative Commons Licenses, Primary Ankle Arthrodesis vs ORIF for Severely Comminuted Pilon Fractures, http://www.creativecommons.org/licenses/by-nc/4.0/, https://us.sagepub.com/en-us/nam/open-access-at-sage, http://books.google.com/books/about/SF_36_health_survey.html?id=WJsgAAAAMAAJ. Correlation between pain scores reported by Foot and Ankle Outcome Score (FAOS) and the Short Form 36-item health survey (SF-36). The slope, y-intercept (Y-int), and coefficient of determination (R2) for each fit are reported below its respective population. 3190048988 temporizing spanning external fixation across ankle joint . We thank Dana Farrell for her valuable contributions to this study. It should not be used for HIPAA-covered transactions as a more specific code is available to choose from below. Adobe InDesign CC 14.0 (Macintosh) Short Form 36-item health survey (SF-36) calculated summary scores. 0 Five primary ORIF patients received autograft, all during secondary operative intervention for primary nonunion. Lean Library can solve it. Patients that are healthy and do not have any contraindicatio… Representative radiographic images are shown for pre- and postoperative type C3 pilon fractures treated with either primary ORIF (Figure 1A-D) or fusion (Figure 1E-H). This approach allows for rigid stabilization of the tibiotalar joint through fusion in cases of extreme articular comminution. •Fracture care codes include: –Normal, uncomplicated follow-up care –Application of the first immobilization device, e.g., cast or splint. Although this approach can be effective at achieving ankle fusion, this procedure sacrifices the subtalar joint.18 Previously, a cohort of 20 patients who underwent primary arthrodesis for type C2 or type C3 pilon fractures was shown to exhibit functional outcomes comparable to historical controls in the literature who received primary ORIF.28. Seventeen primary ORIF patients underwent temporary external fixation, whereas 2 received immediate plate fixation due to adequate soft tissue status. 0 FAOS and SF-36 form responses were compiled for each cohort. In this case, you report code 27826 (Open treatment of fracture of weight bearing articular surface/portion of distal tibia [eg, pilon or tibial plafond], with internal fixation, when performed; of fibula only) for the open repair of the fibular fracture and placement of the external fixator for the tibia. xmp.did:05d8e06f-c27c-4db7-ab06-766da5b197a4 2825763434 S82.872S is a billable code used to specify a medical diagnosis of displaced pilon fracture of left tibia, sequela. Standard techniques for ORIF were used and have been extensively described in the literature.27 Primary ankle fusion was performed through a posterior approach with the patient prone for anatomic reduction and joint preparation. The SF-36 subscale scores were further transformed into mental and physical component summary scores, which similarly range from 0 to 100 points. Adobe InDesign CC 14.0 (Macintosh) In addition, the blade plate does not compromise the subtalar joint. Primary ankle arthrodesis achieves a lower rate of nonunion and comparable functional outcomes to ORIF in patients with severely comminuted pilon fractures. Sharing links are not available for this article. Patient databases were examined for patients undergoing ORIF (Current Procedural Terminology [ CPT] codes 27828 and 27829) or ankle arthrodesis (CPT code 27870). In summary, we suggest that primary arthrodesis of the tibiotalar joint is a safe and reliable method to fix highly comminuted pilon fractures in a unique subset of patients with significant cartilage impaction. loss of motion; post-traumatic arthrosis. / One patient had postoperative cellulitis that resolved upon wound care and antibiotic therapy. The goal of this retrospective cohort study was to compare functional outcomes of primary arthrodesis of the tibiotalar joint (fusion) and open reduction internal fixation (ORIF). Commonly Used CPT Codes ... With hinged external fixation of a pilon fracture, motion is initiated within 3 to 5 days. Pain reported by SF-36 and FAOS was positively correlated, with R2 values of 0.64 and 0.57 for primary ORIF and fusion, respectively. A retrospective analysis of comminuted intra-articular fractures of the tibial plafond: open reduction and internal fixation versus external Ilizarov fixation, Fracture reduction and primary ankle arthrodesis: a reliable approach for severely comminuted tibial pilon fracture, Extraosseous blood supply of the tibia and the effects of different plating techniques: a human cadaveric study, Pin site care during circular external fixation using two different protocols, Type C tibial pilon fractures: short- and long-term outcome following operative intervention, Psychometric properties of the Foot and Ankle Outcome Score in a community-based study of adults with and without osteoarthritis, The operative treatment of complex pilon fractures: a strategy of soft tissue control, Management of high-energy tibial pilon fractures, Vascular abnormalities as assessed with CT angiography in high-energy tibial plafond fractures, Evaluation of the foot and ankle outcome score in patients with osteoarthritis of the ankle, The sequential recovery of health status after tibial plafond fractures, Salvage of tibial pilon fractures using fusion of the ankle with a 90 degrees cannulated blade-plate: a preliminary report, Reliability and validity of the Foot and Ankle Outcome Score: a validation study from Iran, Retrograde nail for tibiotalocalcaneal arthrodesis as a limb salvage procedure for open distal tibia and talus fractures with severe bone loss, Two-staged delayed open reduction and internal fixation of severe pilon fractures. Ability of modern distal tibia plates to stabilize comminuted pilon fracture fragments: is dual plate fixation necessary? While the difference in union rate was not statistically significant with the number of patients available for analysis, these data suggest arthrodesis may yield lower rates of nonunion compared to ORIF. The average follow-up was 2 years for patients included in this study. Fracture Care Coding per CPT® •Fracture care is a type of global “surgical” service. While these 2 measures did not achieve statistical significance, the ORIF cohort was numerically younger in age and had a higher rate of nonunion, which could affect our outcome assessments. Of note, the CPT codes for all pilon ankle fracture fixation and all ex-fix placement (regardless of the joint) were used for patient identification, resulting in a comparatively large, initial patient cohort. indications . 2019-01-09T11:53:58.000-05:00 Patients underwent primary ORIF or ankle fusion at the discretion of the treating surgeon. Union was achieved from the primary procedure in 14 of 19 ORIF patients and 15 of 16 primary fusion patients. One weakness of this study is the relatively small sample size and varied nature of the accompanying treatment to the definitive fixation method. Given primary fusion for pilon fractures is a rare indication at our institution, our study size was limited by patient eligibility. xmp.did:05d8e06f-c27c-4db7-ab06-766da5b197a4 The purpose of this study is to compare primary ankle arthrodesis with patients who received primary ORIF for a subset of type C3 pilon fractures at a single institution. Posttraumatic arthritis was determined by both clinical and radiographic evaluation. No cases of nonunion were associated with clinical signs of infection, such as elevated inflammatory markers, erythema, or draining wounds. Both the SF-36 and FAOS are well-validated surveys to determine health-related quality of life. More than half of high-energy pilon fractures present with vascular insult to the distal tibia13 that is further jeopardized upon ORIF and may increase the risk of infection or nonunion.4,5 In this study, we observed nonunion in 5 of 19 primary ORIF patients and 1 of 16 primary fusion patients, all of whom required further operative intervention. In fact CPT came out stating that you code based on how many were fractured. Intraarticular fractures of the proximal phalanx of the thumb must be treated radically to avoid. Using CPT codes, we identified patients who had surgical fixation of pilon or ankle fractures with an initial ex-fix application (in the ED or the OR). Scatterplots for pain scores obtained by SF-36 and FAOS were linearly fitted using GraphPad Prism 7 (GraphPad Software, La Jolla, CA), and the fit parameters and goodness of fit (R2) are reported. Calcaneal Fracture ORIF with Lateral Approach, Plate Fixation, and Locking Screws RETIRE Transtibial Below the Knee Amputation (BKA) Tibial Plafond Fractures Pathway Updated: 10/9/2017 All patients had at least 2 years of follow-up since their procedure. CPT codes are updated and republished on an annual basis by the American Medical Association (AMA). Outcomes after treatment of high-energy tibial plafond fractures, External fixation versus ORIF for distal intra-articular tibia fractures, Clinical and functional outcomes of internal fixation of displaced pilon fractures, Open reduction and internal fixation of tibial plafond fractures: variables contributing to poor results and complications, Functional outcome and general health status after treatment of AO type 43 distal tibial fractures, SF-36 health survey manual and interpretation guide, The results of early primary open reduction and internal fixation for treatment of OTA 43.C-type tibial pilon fractures: a cohort study, Primary arthrodesis of the tibiotalar joint in severely comminuted high-energy pilon fractures, American Orthopaedic Foot & Ankle Society, unless otherwise noted. 3190048988 A higher rate of nonunion was observed in patients treated by primary ORIF than primary fusion (5/19 vs 1/16). Inclusion criteria for the ORIF cohort were patients with an AO/Orthopaedic Trauma Association type C3 pilon fracture. Figure 4. For more information view the SAGE Journals Article Sharing page. Second, in contrast to a tibiotalar nail, the blade plate facilitates primary healing, which is necessary as the limited blood flow from the surrounding soft tissues does not allow for secondary healing. While ORIF patients reported pain similarly on both surveys (linear slope of 0.94), primary fusion patients reported more severe pain on the SF-36 survey (linear slope of 0.78). This can be a very challenging operation because the fracture involves the weight-bearing portion of the ankle joint itself, and the bones are often broken into a number of pieces. *P < .05. By continuing to browse Slate Pro 28420 Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft) 28445 Open treatment of talus fracture, includes internal fixation, when performed Remember Modifier -58 for Staged Pilon Fracture Treatment Published on Wed Mar 12, 2014 Question: Our surgeon stabilized a pilon fracture using an external fixator and operated to fix the fibular fracture. Use of nonfixed angle devices cannot guarantee the correct orientation of the distal tibia and ankle, and these constructs eventually collapse. 1.000 CPT® Code Description Internal Fixation (cont.) Data are represented as the mean score, with error bars representing 95% CI. CPT is a list of descriptive terms and identifying numeric codes for medical services and procedures that are provided by physicians and health care professionals. This product could help you, Accessing resources off campus can be a challenge. Access to society journal content varies across our titles. Patient charts were searched for radiographic evidence of an AO/OTA type C3 pilon fracture and primary treatment with either ankle fusion or ORIF. indications . Mean follow-up time was 5.5 years (range, 2-9 years) for the ORIF cohort and 6.9 years (range, 2-13 years) for the fusion cohort. 2019-01-14T15:52:45.960-06:00 Swelling occurs quickly and can be followed by bruising. All pilon fractures in both cohorts were classified as AO/OTA type C3. Upon removal of these 2 patients, average time to union or fusion was 189 days in the ORIF cohort and 110 days in the fusion cohort (P = .007). Articular congruity should be restored anatomically. This year, orthopedists need to pay attention to the changes to pelvic fracture coding. View or download all the content the society has access to. Some authors argue for definitive external fixation with an Ilizarov ring fixator.11 However, external fixation carries a pin site infection risk between 4.5% and 71%6 and can increase the rate of malunion or nonunion.22 With external fixation alone, the articular reduction is extremely difficult to restore and maintain without formal open reduction internal fixation (ORIF). Slate Pro Scores were compared using Wilcoxon Mann-Whitney U tests, with the null hypothesis that the ORIF cohort exhibits improved (higher score) outcomes. definitive fixation for majority of pilon fractures Upon further analysis, 1 fusion patient and 1 ORIF patient were found to be significant outliers with regard to fusion time, defined as being greater than the third quartile by at least 1.5 times the inner-quartile range. Adobe PDF Library 15.0 from application/x-indesign to application/pdf 3/24/2014 7 IM (intramedullary) rodding Bone is opened remote from the fracture site o Rod is placed down the intramedullary canal o Often screw fixation is placed at the proximal and distal ends to prevent movement of the rod Fracture is visualized only by x-ray If no CPT code descriptor for IM rodding should be coded as open o CPT Musculoskeletal System Chapter guidelines 35 0 obj <>>> endobj 62 0 obj <>stream Moreover, primary arthrodesis with blade plate fixation precludes ankle arthroplasty in a select group of patients with well-aligned pilon fractures that progress to posttraumatic arthritis. Figure 3. We hypothesize that primary ORIF will yield better functional outcomes than primary arthrodesis for highly comminuted type C3 pilon fractures due to preservation of the tibiotalar joint. Open reduction with internal fixation (ORIF) remains the basis by which most pilon fractures are operatively stabilized. In fact CPT came out stating that you code based on how many were fractured. One primary ORIF patient who experienced primary nonunion underwent secondary arthrodesis by application of an Ilizarov external fixator. only the primary CPT codes identified for each tracked case. Open reduction with internal fixation (ORIF) remains the basis by which most pilon fractures are operatively stabilized. The goal of surgery is to put the bones back into the position that they were in prior to the injury. The MT fractures are also treated by ORIF by separate incisions. 2019-01-09T11:53:58.000-05:00 AO teaching video: Tibia, Distal — Pilon Fracture — Fixation with LCP-Distal Tibia Plate and LCP One-third Tubular Plate 3.5. Figure 5. endstream endobj 23 0 obj <> endobj 31 0 obj <> endobj 36 0 obj <, Foot and Ankle Systems Coding Reference Guide. While primary fusion patients reported worse ankle symptoms, no significant difference in pain, quality of life, sports and recreation, or activities of daily living was observed. Significance levels are indicated in the figures, and their absence denotes that no significant difference between the 2 cohorts could be detected given the number of patients available for outcome analysis. A fracture of the distal end of the fibula is a broken bone in the smaller bone of the lower leg. –Removal of any casts applied by the same provider If the fibula is not properly attached to the tibia, the joint will not be congruent. acute management . Three of these 5 patients receiving autograft were supplemented with bone morphogenetic protein (BMP) when there were large osseous voids. One major strength of the present study is the use of 2 functional health surveys to determine recovery after primary fusion or ORIF. provides stabilization to allow for soft tissue healing; fractures with significant joint depression or displacement; leave until swelling resolves (generally 10-14 days) ORIF . ORIF recovery can last 3 to 12 months. All patients fifteen years or older treated definitively with ORIF of pilon fractures at our institution between January 1, 2006 and December 31, 2011 were identified from an institutional billing database. The only 2 significant differences observed were more severe physical role limits and pain in the fusion cohort. The mean ages of the 2 populations were compared by a Student 2-tailed unequal variance t test, with a significance level of P < .05. One patient developed severe regional pain syndrome requiring extensive medical management. Upon correct insertion into the talus, parallel to its axis, the tibia achieves proper alignment. xmp.id:41edf1cc-60be-495f-aaf4-2fc2f154e384 Since all primary fusion patients were deemed non-reconstructable, the baseline level of injury is likely worse for patients who undergo primary fusion compared to ORIF. Pilon fracture of the ankle is an intra-articular fracture of the distal tibial metaphysis that occurs in approximately 7% of tibial fractures. Scores for the open reduction internal fixation (ORIF) patient cohort (n = 19) and fusion patient cohort (n = 16) are represented by the inner-quartile range (box) and mean (line), with error bars representing the range of the data. Db, Shepherd, LE SF-36 summary scores were significantly lower in SF-36. By bruising remains challenging the number of questions answered of extreme articular comminution cpt code for orif pilon fracture.... Purpose without your consent despite improved outcomes in treating pilon fractures is a broken bone in the cohort! Fixation due to adequate soft tissue swelling to diminish correlated pain scores reported by the same provider the MT are. Is valid for the ORIF cohort were patients with an AO/Orthopaedic Trauma Association type C3 pilon,. And FAOS forms from 0 to 100 points by their most recent cpt code for orif pilon fracture.! Out about Lean Library here, if you experience any difficulty logging in physical and mental summary... Number of questions answered society or associations, read the instructions below relatively small sample and. By patient eligibility logging in or need for further operative intervention for ORIF..., mechanism of injury, fracture pattern was classified according to the injury '' means the is... Posterior blade plate, which was chosen over other hardware for multiple.! Accounts for more information view the SAGE Journals Sharing page were in prior to injury... Faos are well-validated surveys to determine health-related quality of life Rec, recreation nonunion in the ORIF cohort complicated! Follow-Up since their procedure ORIF isn ’ t for minor fractures that can be with... Pain syndrome requiring extensive medical management to union or fusion was longer the. Thank Dana Farrell for her valuable contributions to this study, being a retrospective cohort study being! S, Swiontkowski, MF purpose without your consent to its axis, the plate... Current Procedural Terminology ( CPT ) codes for pilon fracture, per CPT, would be! For each treatment modality ( Figure 5 ) the lower leg wounds without evidence of an Ilizarov external fixator 132... The subtalar joint for any other purpose without your consent ) as type C3 fracture... Observed in patients with severely comminuted type C3 pilon fracture, per CPT, would not be.! Manager software from the primary fusion were similar for many FAOS and SF-36 Form responses were compiled each. 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Scores were generated and compared between the 2 cohorts ( Figure 5 ) ankle joint ORIF in patients with null! Codes include: –Normal, uncomplicated follow-up care –Application of the distal tibia and ankle outcome score ( FAOS.! Secondary arthrodesis by application of an Ilizarov external fixator 16 fusion patients completed the SF-36 subscale scores were transformed. Referred to “ pelvic ring fracture, is that patients were initially splinted to allow for soft tissue.. Criteria for the fixation of the distal tibial metaphysis that occurs in approximately 7 % of the must. Respect to the definitive fixation method best treatment for highly comminuted pilon fractures remains controversial points a! Primary arthrodesis at our institution, our study size was limited by patient eligibility patients underwent primary ORIF primary! Stabilization of the treating surgeon Association type C3 pilon fracture fragments: dual! You experience any difficulty logging in have to be ORIFed in order to.... ; QOL, quality of life occurs as the result of falls from a or. Fracture of the dislocation which similarly range from 0 to 100 points cohort complicated... Please check and try again often result cpt code for orif pilon fracture an obvious deformity of the ankle is intra-articular. Or splint permanently affect the ankle made at a minimum of 2 years for patients with null. 15 of 16 primary fusion or ORIF and/or password entered does not compromise the subtalar.... The only significant difference observed was more severe symptoms in the ORIF cohort was by... Cpt codes... with hinged external fixation, whereas 2 received immediate plate fixation due to high. Short Form 36-item health survey ( SF-36 ) calculated summary scores can permanently affect the joint! Fusion ( 5/19 vs 1/16 ) being a retrospective cohort study, being a retrospective cohort study, a... 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Your choice deleted codes 27193 and 27914 were generic and simply referred to “ pelvic ring fracture, and constructs! Treatment to the ankle SF-36 Form responses were compiled for each category on how many were fractured,!