The American journal of orthopedics
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The purpose of this study was to determine the impact of an Emergency Medicine Department's billing practices on the total cost of care for distal radius fractures. This study identified patients by International Classification of Diseases, Ninth Revision (ICD-9) billing codes treated by the Department of Orthopaedic Surgery (DOS) and Department of Emergency Medicine (DEM) at the University of Arizona. In every case, the surgical modifier 54 was used. ⋯ When the fracture was not manipulated, the total cost of fracture care was increased by $270. Although more than one-third of patients had surgery by the DOS, the DEM used a global billing code that indicates "restorative" treatment. This is an example of the manipulation of Current Procedural Terminology coding to enhance revenue generation with increased cost to the healthcare system, and no added value to outcome.
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Case Reports
Isolated laceration to the deep motor branch of the ulnar nerve by a retained foreign body.
This report describes an isolated laceration to the deep motor branch of the ulnar nerve by a retained foreign body. The patient sustained a laceration on the ulnar, volar aspect of his palm after a fall on gravel. ⋯ Confusion over the patient's intact sensory examination and lack of awareness of the complex distal anatomy of the ulnar nerve contributed to the misdiagnosed nerve lesion. Isolated injuries of the deep motor branch are very rare, but increased awareness and understanding of the complex ulnar nerve distal anatomy will help avoid future delays in diagnosis and treatment.
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Case Reports
Osteochondral autograft and hemiarthroplasty for bilateral locked posterior dislocation of the shoulder.
Posterior shoulder dislocations are rare and account for less than 4% of all shoulder dislocations, with only 6.6% of these proving to be bilateral. More importantly, the majority of posterior shoulder dislocations continue to represent a diagnostic trap for the unwary physician who first sees patients with this condition. ⋯ Posterior bilateral dislocation of the shoulder is still a diagnostic challenge. In the chronic setting, bilateral hemiarthroplasty should be postponed as long as possible since posterior bilateral dislocation is usually experienced by middle-aged active males.