CPT® Code 27227

Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixation

The procedure described by CPT® Code 27227 pertains to the open treatment of acetabular fractures, which are injuries to the acetabulum, the socket of the hip joint where the femur (thigh bone) fits. The acetabulum is a complex structure made up of several components, including the anterior (iliopubic) column, posterior (ilioischial) column, anterior wall, posterior wall, quadrilateral plate (medial wall), and dome. An anterior column fracture occurs when there is a break that extends through the anterior wall and into the ischiopubic segment of the pelvis, while a posterior column fracture involves a break that extends through the posterior wall and disrupts the ilioischial line. A transverse acetabular fracture is characterized by a fracture that crosses both columns but does not completely disrupt the dome of the acetabulum, allowing a portion of the dome to remain attached to the iliac wing. During the procedure, a surgical incision is made over the hip joint to gain access to the fracture site. The hip joint is then thoroughly debrided and irrigated to remove any loose fragments and debris. Following this, the fracture is carefully reduced, and the anatomic alignment is verified using radiographic imaging. To stabilize the fracture, permanent fixation devices are applied, which may include a combination of lag screws and plate and screw devices. In the case of lag screw fixation, the outer cortex of the bone is over-drilled, and the screws are inserted perpendicularly to the fracture site. For plate and screw fixation, a reconstruction plate is positioned along the acetabular surface at the fracture site and secured with lag screws. In instances of posterior column fractures, an additional plate may be placed from the ischial tuberosity to the lateral ilium. Additionally, bone grafts that are separately reportable may be utilized to further secure the fracture fragments, ensuring proper healing and stability of the hip joint.