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A carpometacarpal fracture dislocation of the thumb, commonly referred to as a Bennett fracture, is a specific type of injury that occurs at the base of the thumb. This injury is characterized by a fracture that involves the articular surface of the metacarpal bone, often leading to significant displacement of the fracture fragments. The treatment for this type of fracture typically involves an open reduction procedure, which allows for direct access to the fracture site to ensure proper alignment and stabilization of the bone fragments. During the procedure, an L-shaped incision is made over the skin and subcutaneous tissue of the thumb metacarpal, extending down to the thenar musculature. This approach enables the surgeon to reflect the thenar muscles off the subperiosteal tissue, providing clear visualization of the joint and the fracture site. The area is meticulously cleared of any debris to facilitate the reduction process. To achieve proper alignment, towel-clip forceps may be employed to reduce the fracture and temporarily maintain the alignment of the fragments. In some cases, temporary wire fixation may be utilized to secure the fracture fragments before the application of internal fixation, which is generally necessary for optimal stabilization. Internal fixation can be achieved using either K wires or mini-fragment screws, depending on the specific requirements of the fracture and the surgeon's preference.
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The open treatment of carpometacarpal fracture dislocation of the thumb, or Bennett fracture, is indicated in the following scenarios:
The procedure for the open treatment of a Bennett fracture involves several critical steps to ensure successful outcomes:
After the procedure, appropriate post-operative care is essential for recovery. Patients are typically monitored for any signs of complications, such as infection or improper healing. Pain management strategies are implemented to ensure patient comfort. Rehabilitation may be initiated to restore function and strength to the thumb, with specific exercises tailored to the individual's needs. Follow-up appointments are scheduled to assess healing and to determine when the patient can safely resume normal activities. The overall goal of post-procedure care is to ensure optimal recovery and to restore full functionality of the thumb joint.
| Short Descr | TREAT THUMB FRACTURE | Medium Descr | OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB | Long Descr | Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), includes internal fixation, when performed | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 1 - 150% payment adjustment for bilateral procedures applies. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Surgical procedure on ASC list in CY 2007; payment based on OPPS relative payment weight. | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5B - Ambulatory procedures - musculoskeletal | MUE | 1 | CCS Clinical Classification | 148 - Other fracture and dislocation procedure |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | F5 | Right hand, thumb | FA | Left hand, thumb | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | SG | Ambulatory surgical center (asc) facility service |
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| 2008-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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