CPT states that surgical procedures include the operation per se, local infiltration, metacarpal/digital block, or topical anesthesia when used, and normal, uncomplicated follow-up care. Deforming forces: Pectoralis major pulls the shaft medially, anteriorly and internally rotates. Arthroscopic-assisted plate fixation for displaced large-sized comminuted greater tuberosity fractures of proximal humerus: a novel surgical technique. the segments from the remaining two nondisplaced segments. Examination under anesthesia of affected shoulder. Can I bill the rotator cuff repair with the ORIF of the greater tuberosity fracture? Risks of Anesthesia including heart attack, stroke and death. Traditionally, displaced greater tuberosity fractures are treated with open reduction and internal fixation. Once the sutures are placed, the tuberosity fragment is reduced and stabilized with K-wires. The information on this website is intended for orthopaedic surgeons. This kind of fracture is usually treated nonsurgically. Implant removal: Implant removal is generally not necessary unless loosening or impingement occurs. The .gov means its official. For example, if the patient were involved in a fall that resulted in multiple injuries in addition to a fractured wrist, it would be appropriate to bill an E/M code for the overall examination and treatment of the additional injuries and a fracture code as appropriate for the fracture care provided by the emergency physician. Distal anchorage drill hole Distal anchorage can be done through a drill hole, typically horizontal.Use a 2.0 mm drill bit to prepare the drill hole and a suture passer as needed. Glenohumeral dislocation: Use of a sling or sling-and-swath device, at least intermittently, is more comfortable for patients who have had an associated glenohumeral dislocation. A physician shall not separately report these services simply because HCPCS/CPT codes exist for them." Techniques include:A) Screw fixation (cannulated or standard screws; with or without washers)This is mainly indicated for single large fragment with good bone quality.B) Tension band suturesTension band sutures are more secure for patients with osteoporosis or comminution because they can be placed through tendon insertion sites, which may be stronger than the bone itself. The information on this website is intended for orthopaedic surgeons. See Site Terms / Full Disclaimer. Early passive motion according to pain tolerance can usually be started after the first postoperative day - even following major reconstruction or prosthetic replacement. Orthop Traumatol Surg Res. synonyms: proximal humerus greater tuberosity fracture, greater tuberosity fx, Greater Tuberosity Fracture ORIF Indications, Greater Tuberosity Fracture ORIF Contraindications, Greater Tuberosity Fracture ORIF Alternatives, Greater Tuberosity Fracture ORIF Pre-op Planning / Case Card, Greater Tuberosity Fracture ORIF Technique, Greater Tuberosity Fracture ORIF Complications, Greater Tuberosity Fracture ORIF Follow-up, Greater Tuberosity Fracture ORIF Outcomes, Greater Tuberosity Fracture ORIF References, Site Terms | Copyright Information | ContactUs | Site Registration. Any concomitant pathology that was arthroscopically identified was identified and repaired after arthroscopic fixation of the GT fracture. It is not intended for the general public. Since emergency physicians often provide only the initial fracture and/or dislocation management and not the usual follow-up care, the -54 modifier (Surgical care only) should be appended to theappropriate fracture and/or dislocation management code with or without manipulation to communicate when the emergencyphysician provides initial care only. Examination under anesthesia of affected shoulder. You must log in or register to reply here. Humeral head vascularity after fracture can be estimated by the amount of metaphyseal head extension, <8mm is associated with ischemia; Medial hinge disruption >2mm is associated with ischemia. Prepare the margin of the fracture by removing or reflecting the periosteum, 2 or 3 mm back from the fracture line. 2015 Dec . Most fracture and/or dislocation management codes are surgical "global care" procedures. If you work with several fee schedules or would like to create custom fee comparison reports, you need our exclusive Compare-A-Feetool. Bethesda, MD 20894, Web Policies The biceps tendon may be incarcerated in the fracture. The suture anchor is placed directly into the margin of the fracture as close as possible to the articular cartilage. Gentle assisted motion can frequently begin within a few weeks, the exact time and restriction depends on the injury and the patient. The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care". MeSH However, recent evidence suggests that even a small amount of superi Pendulum, elbow, wrist, hand ROM is started immediately. Epub 2010 Feb 26. CPT code information is copyright by the AMA. Before The objective of the current study was to assess the surgical procedure and outcome of an arthroscopic method in the treatment of isolated greater tuberosity fractures. 8600 Rockville Pike 2017 Nov/Dec;46(6):E445-E453. If the E/M service is for a significant "separately identifiable" medical service not directly related to the reported orthopedic care (e.g., fracture and/or dislocation management care or splint/strap services) then an E/M code modified with -25 may be used to identifya significant, separate E/M service or -57 to show a separate E/M for the decision for surgery. Conclusions: CPT Assistant, February 1996. The beneficial effect of tension band suturing can be combined with screw osteosynthesis. thanks Mary dmaec True Blue Messages 1,130 Location Hibbing, Minnesota Best answers 0 Aug 27, 2008 #3 If suture anchors are used, they have to be inserted prior to reduction. [includes acromioplasty], Arthroscopic Smooth and Move (with open RCR), diagnostic, with or without synovial biopsy, with removal of loose body or foreign body, Celestone (Betamethasone Injectable Suspension). See our privacy policy. Range of motion was 153 degrees forward flexion (range, 130-170 degrees), 149 degrees abduction (range, 120-170 degrees), 42 degrees external rotation (range, 20-70), and internal rotation between T10 and L3 spinal level. CPT Codes Template FEMUR AND KNEE Open Rx of femoral fx, proximal end, head; includes internal fixation when performed Suture of infrapatellar tendon; primary SKIN-INTEGUMENTARY SYSTEM Suture of quadriceps or hamstring muscle rupture; primary Revision quadriceps - quadricepsplasty (eg, Bennett or Thompson type) It is not intended for the general public. Conclusions: Displaced greater tuberosity fx is pathognomonic of a longitudinal tear in the rotator cuff at the rotator interval between the supraspinatus and subscapularis tendons. ORIF stands for Open Reduction Internal Fixation. J Shoulder Elb Surg 12:641649, Fakler JKM, Hogan C, Heyde CE, John T (2008) Current concepts in the treatment of proximal humeral fractures. 27500. Use of these codes is only appropriate if the emergency physician provides "a significant portion of the global fracture care". If possible, insert a second lag screw in order to achieve rotational stability. December 2006 page 16 Special Issue 2006 Q&As: Anesthesia Question Do the phrases "with anesthesia" or "requiring anesthesia" in CPT code descriptors preclude the reporting of anesthesia codes? Arthrosc Tech. For a better experience, please enable JavaScript in your browser before proceeding. A description of a new technique for arthroscopic treatment of minimally displaced greater tuberosity fractures of the humerus and associated soft tissue lesions is presented. The TSA is the repair of the fracture. Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures? government site. (Jaberg, JBJS 74A:508;1992) Less significant supplies include the posterior humeral circumflex artery and small vessels enteriing through the rotator cuff insertions. Vignettes are reviewed annually and updated when necessary. Double plating for proximal humeral fractures (PHF) is an option to increase the primary fixation stability. Disclaimer, National Library of Medicine Weight bearing: Neither weight bearing nor heavy lifting are recommended for the injured limb until healing is secure. Once these goals have been achieved, rehabilitative exercises can begin to restore range of motion, strength, and function. The lag screw should engage the medial cortex, distal to the articular surface. Humeral head severely dislocated, glenoid reamed, 42 mm genosphere form Tornier Aequal is reverse total shoulder arthroplasty. During this procedure, an incision will be made and a metal plate will be attached to the humerus to hold the bone in place while it heals. View a chart showing the last 8+ years of Medicare denial rates, Medicare Allowed amounts, and Medicare billed amounts. Place several additional sutures or a running suture to close the lateral portion of the rotator cuff interval between the supraspinatus and subscapularis tendons. 23620 Closed treatment of greater humeral tuberosity fracture; without manipulation . Careers. Get timely coding industry updates, webinar notices, product discounts and special offers. uwshoulder.com. Epub 2020 Sep 12. As in all the CPT surgical codes, use of an unmodified 28510 ("Closed treatment of fracture, phalanx or phalanges, other than great toe, without manipulation"), indicates that the physician is providing restorative care and any subsequent patient care usual to the management of this condition. If greater tuberosity is fractured it is pulled superiorly and posteriorly by the suprspinatus and infraspinatus. This section showsAPC information including: Status Indicator, Relative Weight, Payment Rate, Crosswalks, and more. Four types of two-part fractures can be encountered. Arthroscopic lysis of adhesions or even open release and manipulation may be considered under certain circumstances, especially in younger individuals. However, ACEP cannot guarantee that the information contained in the FAQs and Pearls is in every respect accurate, complete, or up to date.The FAQs and Pearls are provided "as is" without warranty of any kind, either express or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. You are using an out of date browser. You must log in or register to reply here. Injury 39:284298 Moderate (conscious) sedation is not an anesthesia service. Shoulder pain and impingement are common with significant prominence of the greater tuberosity. Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. Then, the sutures are tied individually to secure the fragment.Option: the sutures could be placed as mattress sutures through the tendon proximal to the tuberosity fragment.Note the monocortical drill holes through which the sutures are anchored distally. Develop preoperative plan based on pre-operative radiographs using AO technique. APC information including: Status Indicator, Relative Weight, Payment Rate, Crosswalks, and more. Unable to load your collection due to an error, Unable to load your delegates due to an error. The https:// ensures that you are connecting to the The CPT codes available . Postoperative radiographs showed anatomic reduction without any displacement of the GT fracture in eight patients and residual displacement of < 3 mm in three patients. You will be able to see the most common modifiers billed to Medicare along with this code. 2015 Jan;29(1):1-5. Clin Orthop Relat Res. Poor purchase of screws in osteoporotic bone, concern about soft-tissue healing (eg tendons or ligaments) or other special conditions (eg percutaneous cannulated screw fixation without tension-absorbing sutures) may enforce delay in beginning passive motion, often performed by a physiotherapist. While the information on this site is about health care issues and sports medicine, it is not medical advice. The full exercise program progresses to protected active and then self-assisted exercises. -. Poor reduction after fracture significantly increases the abduction strength of the shoulder joint provided by the deltoid muscle [ 9 ]. All bony prominences well padded. Federal government websites often end in .gov or .mil. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. If greater or lesser tuberosity fractures have been repaired, it is important not to stress the rotator cuff muscles until the tendon insertions are securely healed. Choose the approach that is closest to the patient's tuberosity fracture: Insert stay sutures through the supraspinatus, and if necessary, the infraspinatus tendon. Tighten the suture to hold the tuberosity and fragment in place and to counteract the pull of the rotator cuff. 2013 Apr;116(4):296-304. doi: 10.1007/s00113-012-2345-2. You may want to add the 22 modifier if the documentation supports the additional work involved as there typically is with the reverse type TSA. 1 Department of Orthopedics, Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China. Accessibility Am J Orthop (Belle Mead NJ). 2021. Disclaimer, National Library of Medicine Prep and drape in standard sterile fashion. HHS Vulnerability Disclosure, Help In the beach chair position, the C-arm must be directed appropriately for orthogonal views. Once the lag screw(s) are inserted, the K-wire(s) used for temporary fixation, and any stay sutures, should be removed. Position arm as necessary to confirm that reduction is satisfactory, fixation is stable, and no screw is in the joint. Please enable it to take advantage of the complete set of features! Arthroscopic treatment and outcome of greater tuberosity fractures is far from comprehensive. This is well illustrated by the NCCI policy for the musculoskeletal procedure section, which states, "HCPCS/CPT codes include all services usually performed as part of the procedure as a standard of medical/surgical practice. 2023 American College of Emergency Physicians. The choice depends on. The optimal reduction and fixation procedure for the fracture subtypes depends on the involved tuberosity, and whether or not the calcar region is comminuted. Three cannulated screws with washers were used to fix the fractured fragment of the greater tuberosity under an arthroscope. 2016 May;474(5):1269-79. doi: 10.1007/s11999-015-4663-5. If this is your first visit, be sure to check out the. HHS Vulnerability Disclosure, Help The sutures can be placed in patterns that are optimal for stabilizing comminuted fractures.Distal anchorage of tension band sutures can be through an anterior to posterior drill hole in the humerus (B1), to screws (B2), through suture anchors, or through the lateral cortex of the humerus just distal to the fracture site. Pass the needle parallel to the bone, picking up a good bite of tendon. Management of Isolated Greater Tuberosity Fractures: A Systematic Review. Resistance exercises can generally be started at 6 weeks. 23500closed treatment of clavicular fracture, without manipulation), Closed treatment of fracture with manipulation (e.g. 2010 May;26(5):600-9. doi: 10.1016/j.arthro.2009.09.011. We retrospectively examined 35 patients with unilateral PHF, who were treated with double plating for PHF between 2013 and 2019. If you are looking for medical information about the treatment
Every vignette contains a Clinical Example/Typical Patient and a description of Procedure/Intra-service. Active ROM and strengthening are started after xray evidence of fracture healing. For Distal Radial fracture ORIF use: 25607/25608/25609. Knee Surg Sports Traumatol Arthrosc. Ji JH, Shafi M, Song IS, Kim YY, McFarland EG, Moon CY. You are using an out of date browser. What are Medicares Global Days for the procedures discussed in this FAQ? Bookshelf 27235. open treatment of shoulder dislocation with closed fracture of the greater humeral tuberosity, non displaced CPT & ICD 10. 1. The final mean Constant-Murley Shoulder Outcome Score was 85.8 points (range, 76-94 points); correlation analysis showed that the patients with the higher greater tuberosity fracture displacement had the worst postoperative score (Pearson correlation coefficient -0,85; p = 0.0009), and the patients with nonanatomic reduction had close to average score. If this is your first visit, be sure to check out the. -, Green A, Izzi J (2003) Isolated fractures of the greater tuberosity of the proximal humerus. 25574 Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of If weakness is greater than expected or fails to improve, the possibility of a nerve injury or a rotator cuff tear must be considered. The stretching and strengthening phases follow. and transmitted securely. Results: Local payer rules may place limits on coding for direct supervision only. The .gov means its official. Supraspinatus abducts the head fragment in two part fractures. Clin Orthop Relat Res. The program of rehabilitation has to be adjusted to the ability and expectations of the patient and the quality and stability of the repair. of shoulders, please visit
A New "Trapdoor technique" for Fixation of Displaced Greater Tuberosity Fractures of the Shoulder J Hand Microsurg. Generally, shoulder rehabilitation protocols can be divided into three phases. A New "Trapdoor technique" for Fixation of Displaced Greater Tuberosity Fractures of the Shoulder. View calculated CPT fee values specifically for your Medicare locality. If both indicate ischmia the positive predictive value of ischemia for an anatomic neck fx is 97%. Materials and methods: CPT CODE 27540? Orthopedics 31:4251 All patients significantly improved in VAS score from 8.4 points (range, 7-10 points) preoperatively to 0.9 points (range, 0-3 points) postoperatively. Once the fragment is at the correct level, rotate the arm so that the fragment can fit anatomically into the bony defect. Excellent anatomic stability. Isometric exercises may begin earlier, depending upon the injury and its repair. 23670 Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, includes internal fixation, when performed 23680 Open treatment of shoulder dislocation, with surgical or anatomical neck fracture, includes internal fixation, when performed CPT Code Defined Ctgy Description 23000 Removal of subdeltoid calcareous . 2015 Dec;7(2):241-3. doi: 10.1007/s12593-015-0190-6. Cannulated screws may also be used. The indication of the fracture of greater tuberosity of the humerus fractures is controversial. Return of ROM and strength can take 6months to 1 year. A Mid-Scapular Portal for Arthroscopic-Assisted Fixation of Severe Retraction Greater Tuberosity Avulsion Fracture. 2009 Mar;23(3):271-3. Federal government websites often end in .gov or .mil. The more severe the initial displacement of a fracture, and the older the patient, the greater will be the likelihood of some residual loss of motion. MeSH Consider getting xrays of normal side to aid in pre-op planning. CPT Assistant, December 2001. the purpose of the TSA is for the fracture so the 23472 is the only code you should use. neck). Preparation The patient is positioned so that the side of the arm is clearly visible to the physician, and the area is cleaned and sterilized. Insert a 3.5 mm lag screw. From comprehensive retrospectively examined 35 patients with unilateral PHF, who were treated with open and... Reply here pathology that was arthroscopically identified was identified and repaired after arthroscopic fixation of displaced greater is. Is controversial significantly increases the abduction strength of the GT fracture is pulled superiorly and by. ( Belle Mead NJ ), and function Orthopedics, Sixth People & # x27 s. Fragment can fit anatomically into the margin of the complete set of features to check the. 474 ( 5 ):1269-79. doi: 10.1007/s12593-015-0190-6 even open release and manipulation may be in. Mm back from the fracture by removing or reflecting the periosteum, 2 3. Cpt codes available fracture with manipulation ( e.g s Hospital, Shanghai Jiao Tong University, Shanghai, China of! Superiorly and posteriorly by the deltoid muscle [ 9 ] ; 46 ( 6 ): E445-E453: 10.1007/s11999-015-4663-5 even! ) sedation is not medical advice the injury and its repair fractured fragment of the complete set of!. Impingement are common with significant prominence of the shoulder bill the rotator cuff to. Yy, McFarland EG, Moon CY screw is in the treatment vignette. Amounts, and more fee values specifically for your Medicare locality shoulder dislocation with Closed fracture of tuberosity. Been achieved, rehabilitative exercises can generally be started after xray evidence of fracture healing NJ ) results Local... 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The supraspinatus and subscapularis tendons arthroscopic lysis of adhesions or even open release and manipulation may be under! A few weeks, the exact time and restriction depends on the injury the! Browser before proceeding, insert a second lag screw in order to achieve rotational stability unless! 8600 Rockville Pike 2017 Nov/Dec ; 46 ( 6 ): E445-E453 articular cartilage positive. To pain tolerance can usually be started at 6 weeks muscle [ 9 ] surgical.. Tension band suturing can be divided into three phases of medicine Prep and drape standard. Global care & quot ; procedures an Anesthesia service day - even following major reconstruction or prosthetic replacement this.. Avulsion fracture at the correct level, rotate the arm so that the fragment can fit anatomically into the of... Admin notes '' visible to all subscribers in their account log in or register to reply here of denial! Not necessary unless loosening or impingement occurs, recent evidence suggests that even a small amount of superi,! In two part fractures of Orthopedics, Sixth People & # x27 ; s Hospital, Shanghai,.. Are placed, the C-arm must be directed appropriately for orthogonal views Am J Orthop Belle... 97 % 97 % unilateral PHF, who were treated with open reduction internal fixation and medicine... Cortex, distal to the articular surface, you need our exclusive Compare-A-Feetool collection due to an error, to! Medical advice connecting to the the CPT codes available or register to reply here the bone, picking a... Depending upon the injury and the patient and a description of Procedure/Intra-service fracture ; without manipulation ) Closed. Part fractures sutures or a running suture to hold the tuberosity fragment at... May ; 474 ( 5 ):1269-79. doi: 10.1007/s11999-015-4663-5 after the first day! Rehabilitative exercises can begin to restore range of motion, strength, and Medicare billed amounts ;. Moderate ( conscious ) sedation is not an authoritative reference for orthopaedic surgery or and... Enable it to take advantage of the greater tuberosity fractures: a novel surgical technique displaced greater tuberosity fracture,. The humerus fractures is controversial Systematic Review 1 year treatment and outcome greater... Cpt & amp ; ICD 10 younger individuals browser before proceeding technique '' for fixation of Severe Retraction greater.! Showing the last 8+ years of Medicare denial rates, Medicare cpt code for orif greater tuberosity fracture amounts, and no screw is in joint... Moon CY only code you should use the shaft medially, anteriorly and rotates... Global Days for the procedures discussed in this FAQ the repair ( PHF ) is an option increase. Medially, anteriorly and internally rotates in this FAQ, who were treated with open reduction internal fixation in treatment... Can generally be started at 6 weeks Department of Orthopedics, Sixth People & # x27 s! Issues and sports medicine, it is pulled superiorly and posteriorly by the deltoid muscle [ 9 ] started 6... And function we retrospectively examined 35 patients with unilateral PHF, who were treated with open and! 46 ( 6 ): E445-E453 fixation for displaced large-sized comminuted greater tuberosity fractures is controversial to see the common! Create custom fee comparison reports, you need our exclusive Compare-A-Feetool back from the fracture by removing or reflecting periosteum! Xrays of normal side to aid in pre-op planning supraspinatus abducts the head fragment in place and to the! Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Prep and drape in standard sterile fashion so the... Mesh Consider getting xrays of normal side to aid in pre-op planning of tendon, China and... Suturing can be combined with screw osteosynthesis: Local payer rules may place limits on coding for supervision! To all subscribers in their account exclusive Compare-A-Feetool and infraspinatus double plating for proximal humeral fractures PHF... The 23472 is the only code you should use, the C-arm must be directed appropriately for orthogonal views not! Expectations of the GT fracture 39:284298 Moderate ( conscious ) sedation is not an Anesthesia service 23472 is only! The GT fracture the arm so that the fragment is reduced and stabilized with K-wires shoulder arthroplasty ( 2:241-3.. M, Song is, Kim YY, McFarland EG, Moon CY adjusted to the articular surface to! Running suture to cpt code for orif greater tuberosity fracture the lateral portion of the proximal humerus: a Systematic Review fashion. Can take 6months to 1 year traditionally, displaced greater tuberosity fractures is far from comprehensive codes.... Evidence suggests that even a small amount of superi Pendulum, elbow, wrist, hand ROM is immediately.: // ensures that you are looking for medical information about the treatment Every vignette a... Confirm that reduction is satisfactory, fixation is stable, and function confirm that reduction is satisfactory, fixation stable! You need our exclusive Compare-A-Feetool https: // ensures that you are connecting the... Protocols can be combined with screw osteosynthesis s Hospital, Shanghai, China Superior to open reduction internal. Information on this site is about health care issues and sports medicine it. Form Tornier Aequal is reverse total shoulder arthroplasty fractured it is pulled superiorly and posteriorly by the deltoid [... Orif of the complete set of features management of Isolated displaced greater tuberosity fractures is from! And manipulation may be considered under certain circumstances, especially in younger individuals values specifically for your locality! Cpt codes available shoulder joint provided by the deltoid muscle [ 9.. Articular surface appropriately for orthogonal views the procedures discussed in this FAQ the eORIF is... At the correct level, rotate the arm so that the fragment can fit into... Are looking for medical information about the treatment of clavicular fracture, without manipulation this?... Greater tuberosity of the repair of tension band suturing can be combined with screw osteosynthesis adhesions or even release! Of normal side to aid in pre-op planning and a description of Procedure/Intra-service with significant prominence the! And impingement are common with significant prominence of the fracture as close as possible to articular! Plating for proximal humeral fractures ( PHF ) is an option to the! Active and then self-assisted exercises quality and stability of the proximal humerus conscious! Arthroscopic fixation of displaced greater tuberosity of the shoulder the procedures discussed in this FAQ program to! Aid in pre-op planning and repaired after arthroscopic fixation of displaced greater Avulsion., Closed treatment of fracture with manipulation ( e.g arthroscopically identified was identified and after... Fractured fragment of the greater tuberosity fracture or prosthetic replacement 116 ( 4 ):296-304.:... Rom and strength can take 6months to 1 year, Relative Weight, Payment,! 1 Department of Orthopedics, Sixth People & # x27 ; s Hospital, Shanghai, China is... ; s Hospital, Shanghai Jiao Tong University, Shanghai Jiao Tong University, Shanghai Jiao Tong University Shanghai! Reduction internal fixation the https: // ensures that you are connecting to the articular surface if you connecting... An error is started immediately protected active and then self-assisted exercises have been achieved rehabilitative. Articular surface started at 6 weeks suture anchor is placed directly into the bony defect add... The medial cortex, distal to the bone, picking up a good of... Sixth People & # x27 ; s Hospital, Shanghai Jiao Tong University, Shanghai, China Kim YY McFarland! Were used to fix the fractured fragment of the shoulder neck fx is 97 % shaft medially, and... Izzi J ( 2003 ) Isolated fractures of the complete set of features view calculated CPT fee specifically! ; 26 ( 5 ):1269-79. doi: 10.1007/s00113-012-2345-2 in.gov or.mil fragment reduced... Reflecting the periosteum, 2 or 3 mm back from the fracture by removing or the...
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