open and closed reduction

in addition to being an rn i am a medical coder. we need to know the definitions of medical procedures and medical diagnoses. maybe you will find these explanations helpful.

fracture reduction

reduction is a medical procedure that is also known by the name of "manipulation". it is the most common procedure performed in the treatment of a fracture. it involves moving the bone fragments that might have been displaced into as nearly normal an anatomic position as possible. an important concept to grasp is that not all bones become displaced when they are fractured. examples would be linear or simple types of fractures. whether or not any internal or external fixation will be done as a treatment for a fracture depends on the general condition of the patient, the presence of any associated injuries and the type and location of the fracture. reduction, or manipulation, is sometimes accomplished by merely pulling on the opposite ends of an extremity to separate the two broken pieces of bone (being held tightly in displacement by muscle spasm) and accomplishing anatomical re-alignment. this is often done with fractures of the fingers and wrists.

internal fixation

with internal fixation the physician makes a incision to expose the bone that needs treatment. "internal fixation includes the use of pins, screws, staples, rods, and plates that are inserted into the bone to maintain alignment. when the fractured bone is in good alignment so that no manipulation is necessary, internal fixation may be used to stabilize the bone without any fracture reduction being performed. internal fixation is also used without reduction when it is necessary to reinsert an internal fixation device because the original is either displaced or broken." (page 319-320, faye brown's icd-9-cm coding handbook, 2005 revised edition, american hospital association)

external fixation

many more different procedures are done by external fixation. external fixation involves the external application of something that will stabilize an injury such as a muscle sprain or a simple fracture. if the injury is a fracture "one or more pins or wires may be used. small stab incisions are made in the skin and a drill is used to make a hole into the bone. each pin or wire is inserted into the bone through the drill holes and secured to an external fixation device. this holds the fracture or joint in a stable position (page 260 of the ingenix coder's desk reference)."

external fixation is also accomplished by noninvasive means such as traction or the use of casts or splints. the types of traction that are considered external fixation include:

• skin traction with tape, foam or felt
  
• skeletal traction with wires or pins drilled transversely through the bone and exiting through the skin
  
• cervical spinal traction, such as baron's tongs, crutchfield tongs and halo skull traction
  
• upper extremity traction such as dunlap's skin traction
  
• lower extremity traction such as buck's extension skin traction, charnley's traction, hamilton-russell's traction, balanced suspension traction and fixed skeletal traction.

a specific type of external fixation device used to stabilize a fractured bone is called a minifixator. it is applied under general anesthesia but considered external fixation because the bone is never openly exposed during the procedure. holes are drilled into both proximal and distal portions of the involved bone. pins are inserted through the bone and attached to the metal frame of the fixator. the pins are located internally except for the portion to which the external frame is connected. you've probably seen these on people's legs. they look like steel rods encircling the entire person's lower leg like an open cylinder.

http://www.orthofix.com/products/sheffield.asp?cid=16 - the sheffield fixator, a type of external fixation device used for fractures. pictures of the fixator are on the right side of the page.

yeah, isn't that amazing! the hospital coders have to get an aa degree in this subject. i'm learning so much as a coder that i didn't know as an rn!

you might try http://www.or-live.com/ - or live--live broadcasts of surgeries if you have dsl connection. they might have an achieved surgery of some orthopedic procedures that you can watch so you can see some of this stuff being done. if you can do it in clinical, ask to shadow an orthopedic surgeon and let him know you specifically want to get an understanding of the difference between these procedures. i'll bet you'll be able to find a willing doc.

I like both. I miss clinical nursing terribly. I like working with the numbers and the coding. It's fun to kind of be on the doctor's backs about their documentation. Ha! Ha! Payback!!! And, they do listen because the hospitals get ticked off if the doctor's documentation is the cause of them losing money on their billing. Of course, they would lose money in their private practices as well if they weren't documenting properly either. Still, I miss the patient contact. An experienced coder makes almost as much, sometimes more than an RN, did you know that?

Nurses aren't the only important workers in the healthcare industry! HIPAA and Medicare opened the floodgates to HIM (Health Information Management--used to be called Medical Records) careers.