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A 16-year-old female was brought to the ED by an ambulance after a head-on motor vehicle collision. She admits to left thigh and right ankle pain. She denies any numbness or tingling in either extremity. Additional trauma survey was negative for other neurologic or visceral injuries.
No relevant past medical history
Focused examination of the left lower extremity shows mild deformity and significant swelling about the thigh. A thigh wound is noted laterally with exposed fat and venous ooze which probes down to bone. She is neurovascularly intact. Focused examination of the right lower extremity demonstrates deformity, swelling and ecchymosis about the right ankle. Significant tenderness is noted. The skin appears intact. DP/PT pulses are palpable but sensation and motor function are diminished.
Irrigation and Debridement (CPT 11012), Intramedullary Nailing Left Femur (CPT 27245) & Open Reduction Right Talus Fracture with Application of Ankle Spanning External Fixator (CPT 20692)
Open Reduction Internal Fixation Right Talus (CPT 28445) & Open Reduction Internal Fixation Distal Fibula (CPT 27814)