CPT® Code 27822

Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip

A trimalleolar ankle fracture is a complex injury that involves all three malleoli: the lateral malleolus, which is the bony prominence on the outer side of the ankle formed by the distal fibula; the medial malleolus, located at the distal end of the tibia and forming the inner aspect of the ankle; and the posterior malleolus, also known as the posterior lip, which is the bony process at the back of the tibia. The open treatment of this type of fracture, coded as CPT® 27822, includes the necessary internal fixation when performed, specifically addressing the medial and/or lateral malleolus, while noting that fixation of the posterior lip is not included in this code. The procedure typically begins with a lateral incision over the fracture site to access the lateral malleolus, ensuring that the branches of the superficial peroneal and sural nerves are protected during dissection. The periosteum is elevated to expose the fracture, which is then cleared of debris. The fracture is reduced and maintained using a bone clamp, with radiographic checks to confirm proper alignment. If internal fixation is indicated, a guidewire is inserted through the fracture site, followed by the application of a fixation device, such as a plate and screws. A second incision may be made over the medial malleolus to similarly expose and treat that area, with the possibility that open reduction of one malleolus may lead to spontaneous reduction of the other. This procedure is critical for restoring stability and function to the ankle joint, allowing for proper healing and recovery.