CPT® Code 27823

Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lip

A trimalleolar ankle fracture is a complex injury that involves all three malleoli: the lateral malleolus, medial malleolus, and posterior malleolus (also known as the posterior lip). The lateral malleolus is the bony prominence located on the outer side of the ankle, formed by the distal fibula. The medial malleolus is found at the distal end of the tibia and constitutes the bony prominence on the inner side of the ankle. The posterior malleolus is situated at the back of the tibia and plays a crucial role in the stability of the ankle joint. The open treatment of this type of fracture includes the necessary internal fixation to ensure proper alignment and stabilization of the fractured bones. The procedure typically begins with a lateral incision over the fracture site, allowing the surgeon to carefully isolate and protect the surrounding nerves, such as the superficial peroneal and sural nerves. Following dissection, the periosteum is elevated to expose the fracture, which is then cleared of any debris. The fracture is reduced and maintained using a bone clamp, with radiographic checks to confirm proper alignment. If internal fixation is deemed necessary, a guidewire is inserted through the fracture site, followed by the application of a fixation device, such as a plate and screws. In some cases, the open reduction of one malleolus may lead to the spontaneous reduction of the other malleolus, potentially reducing the need for additional surgical intervention. The procedure may also involve a second incision over the medial malleolus, where similar steps are taken to expose, reduce, and fixate the fracture. Additionally, if the posterior lip requires reduction and fixation, further surgical steps are taken to ensure its proper alignment and stabilization.