Anatomy for Hand Fracture Management. ICD-9-CM Fracture Coding Care of complications of fractures, such as a malunion or a nonunion, are coded with appropriate codes for those conditions 733.81 and 733.82, respectively. Generally, recovery takes 3 to 12 months. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Nevertheless, it . Theyll also check the nerves near the broken bone. Contact our Account Receivables Specialist today! An area of 3 cm x 4 cm was dark. Metacarpal neck fracture left icd-10. A pin is placed through the tip of the affected finger for finger fractures, or in the back of the affected hand for metacarpal fractures. Information in this article has been reviewed by members of the AAOS Coding, Coverage, and Reimbursement Committee. The main goal of our organization is to assist physicians looking for billers and coders. (2015). Sutures will remain in place for 10-14 days. If plate is not pre-bent the volar cortex will gap open when the plate is secured. Or lateral CPT 24358 - How to Increase Revenue of Behavioral Health Practice? These injuries are usually fractures that are displaced, unstable, or those that involve the joint. Every surgery is different. A physical or occupational therapist can show you specific rehabilitation exercises. Are you looking for more than one billing quotes? Since orthopedic surgeon Sir Robert Jones first described these fractures in 1902, there has been an abundance of literature focused on the proximal aspect of the fifth metacarpal due to its tendency towards poor bone healing. Two days later, the patient was returned to OR and the dressing was removed. The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care". synonyms: Bennett fracture, thumb fracture, thumb metacarpal fracture ORIF. Metacarpal Neck Fracture ORIF/ CRPP 26615. 2012-05-20 20:03:35. While coding note that, debridement is separately billable when it makes up a significant portion of the procedure. A: AMA CPT rules describe codes 26615 and 26605 as follows: Note that in each description the instructions are to report the procedure code for each bone. Your scenario, as described, would be reported with 26615 and 26605-59. Despite the increasing success rate of ORIF, recovery depends on your: ORIF is performed by an orthopedic surgeon. But the same concept does not apply to meniscal repairs (29882 and 29883). All rights reserved. Typically follow up appointments are scheduled in two-week intervals following surgery, so we can monitor your recovery. 26615Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone, 26605Closed treatment of metacarpal fracture, single; with manipulation, each bone. However, a subset of metacarpal shaft or neck fractures cannot be reduced by closed means or are unstable after reduction. With the pins in place, the stability of the fracture fixation and the rotational alignment are . People seeking specific medical advice or assistance should contact a board certified physician. AAOS Now / Medicare does have a zero modifier for CPT code 29877. The fractures were angulated and the fingers were not aligned well. We avoid using tertiary references. Site Terms | Copyright Information | ContactUs | Site Registration. Visit www.aaos.org/coding for more coding information. As with any surgery, there are potential risks and side effects associated with ORIF. ORIF isnt for minor fractures that can be healed with a cast or splint. Modifier 59 would be appended to the lesser-valued procedure (26605) to indicate that the nonmanipulative treatment of the fracture is for a separately identifiable bone. All Rights Reserved. ORIF recovery can last 3 to 12 months. ORIF is performed by an orthopedic surgeon. You will be sent for a custom splint that is removable for showering ONLY. But there are things about getting around that youre just not ready for. If you have questions about coding or want to suggest a topic for a future coding article, email aaoscomm@aaos.org. As mentioned earlier, open fractures have considerable contamination with foreign bodies and devitalized tissue. If you have a serious fracture, your doctor might recommend open reduction internal fixation (ORIF) surgery. Metacarpal fractures are among the most common hand injuries, often caused by a direct blow to the hand or by axial load. Progress with ROM exercises. The surgeon will attach metal rods, screws, plates, or pins to the bone to hold it together. Injury to the metacarpal head may have a severe effect on hand function but few studies have investigated the management of this condition. All About Fractures of the 5th Metatarsal, What to Know About Distal Radius Fractures: Treatment, Recovery, and More, What to Know About a Stress Fracture in the Foot, What You Need to Know About a Broken Wrist. Q: The podiatrist in our office recently performed an arthrodesis procedure that required bone graft to be harvested from the iliac crest. Youll need physical or occupational therapy, pain medication, and lots of rest. Q: Can we report CPT codes 26615 and 26605 when a patient has multiple metacarpal fractures and the physician manages the fractures in the same session? Please log in to access this article. Metacarpal Fracture Procedure CPT Codes Closed treatment of metacarpal fracture, single; without manipulation, each bone (26600) Closed treatment of metacarpal fracture, single; with manipulation, each bone (26605) Closed treatment of metacarpal fracture, single; with manipulation, with internal or external fixation, each bone (26607) Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. You will wear your splint at all times for 4-6 weeks. The official definition of CPT code 26600 (Closed treatment of metacarpal fracture, single; without manipulation, each bone) instructs the physician to report CPT code 26600 for each bone that is fracture and treated without manipulation. In such cases, you should accurately report all of the work involved. Place in removable splint with fingers buddy-taped. People seeking specific medical advice or assistance should contact a board certified physician. The information on this website is intended for orthopaedic surgeons. Last medically reviewed on January 16, 2019. This surgery is performed on an outpatient basis meaning you will be able to go home that day. 26645. I reviewed CPT 20900 but thought not to bill because it states 'autogenous' bone graft/harvest. Michael J. Garcia, MD, (Tampa, FL) presents metacarpal fracture fixation using an intramedullary, partially threaded Compression PT Screw. The surgeon will cut the skin and move the bone back into the normal position. Here's how to tell if your wrist is broken and what to. synonyms:metatarsal fracture ORIF, open treatment metatarsal fracture, Metatarsal Fracture ORIF Contraindications, Metatarsal Fracture ORIF Review References, Site Terms | Copyright Information | ContactUs | Site Registration. cpt code for orif greater tuberosity fracture. Address : 823 129th Infantry Drive,Suite 103, Joliet, IL 60435. You should contact your doctor if you experience bleeding, increasing pain, or other new symptoms during recovery. Metatarsal Fracture ORIF Alternatives. Podiatric bone graft While the information on this site is about health care issues and sports medicine, it is not medical advice. The surgery should help reduce pain and restore mobility by helping the bone heal in the right position. My MAC approved one. 1 0 obj 4 0 obj After ORIF ankle surgery, you wont be able to walk for some time. After the bone heals, this hardware isnt removed. These problems are rare. CPT Codes for Hand and Finger Fractures: ICD Counterpart Codes: Closed Treatment without Manipulation: Closed Treatment with Manipulation: Closed Reduction with External Fixation: Percutaneous Pin Fixation: Open Reduction with or without Fixation: Metacarpal: Bennett: Phalangeal Shaft, Proximal / Middle: summary. Staying off your ankle will prevent complications and help the bone and incision heal. You may be a candidate for ORIF if you have a serious fracture that cant be treated with a cast or splint, or if you already had a closed reduction but the bone didnt heal correctly. 2 0 obj Your doctor might recommend ORIF if your bone: ORIF may also help if the bone was previously re-aligned without an incision known as closed reduction but didnt heal properly. 0 . It is not intended for the general public. Bennett Fractrue ORIF CPT. (May compress in syringe for firmer graft), Splint in "safe" position (wrist extended 15-20 degrees, MCP joints flexed 70 degrees, PIP joint in 0-10 degrees flexion), Post-op: Splint in "safe" position (wrist extended 15-20 degrees, MCP joints flexed 70 degrees, PIP joint in 0-10 degrees flexion), 7-10 Days: remove splint. Usually performed in an emergency department or orthopedic clinic with light sedation and analgesia, the fracture is manipulated back into anatomic alignment and immobilized with a cast, brace or splint.Occasionally general anesthetic may be required. Conclusions: Although for both techniques good functional outcomes were reported, the significance of the functional impairment after ORIF requiring reoperation suggests ORIF to be a less favorable technique for single, closed metacarpal shaft fractures. After a joint reconstruction, we have been billing for a joint injection for pain management or aspiration of an effusion in the operated joint with a modifier 58. They are described by the appearance of their respective fracture patterns and can be divided by transverse, oblique, spiral, and comminuted. 3 Months: Check xrays. Specialist surgical procedure used to fix fractures. You will follow up with us in the office 1-2 days after the procedure. 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. The area was then copiously irrigated, and a dressing was placed. Codes 1101011012 can be used for debridements performed at the same time as the fracture reduction and fixation or for initial debridement and reduction at a later date. This column addresses recently asked questions on coding orthopaedic procedures. At surgery the following day an open reduction and internal fixation (ORIF) of the left fifth metacarpal head fracture was performed. You may be correct if the payor is Medicare and hence the confusion sets in. If the hardware gets infected, it might need to be removed. Some nonviable muscle tissue was also debrided. For thumb metacarpal fractures, fashion a thumb-spica splint with the IP joint free. A Bennet fracture is an intra-articular fracture of the 1st metacarpal fracture caused by an axial force applied to the thumb in flexion, that requires surgical fixation when displaced. Debridement is used to remove foreign material or damaged, dead, or contaminated tissue from a surgical field, wound, or injury. Metacarpal base fractures can present as both extra and intra-articular injuries. But if the chondroplasty is performed in a different compartment, Medicare instructs the physician to report G0289. Fractures Question: "The emergency de-partment referred me a patient with three non-displaced metatarsal frac-tures right foot. Debridement is used to promote healthy healing of damaged skin, tissue, muscle, or bone. The metacarpal shaft fractures are often produced by longitudinal compression, torsion, or direct impact. How do we report this procedure? Metacarpal Fracture with ORIF 1160 Kepler Drive 1 | Page Green Bay, WI 54311 920-288-5555 . They're common injuries in athletes or dancers but can happen. Surgery was recommended for the patient. See Site Terms / Full Disclaimer. Open reduction internal fixation (ORIF) involves a surgical approach to "reducing" or resetting the bones. He was treated with a Rolando Fracture Hook Plate from the Acumed Hand Fracture System. Depending on your fracture and risk for complications, your procedure might be done immediately or scheduled in advance. Internal fixation means the bones are held together with hardware like metal pins, plates, rods, or screws. A spiral fracture, also known as torsion fracture, is a type of complete fracture that occurs due to a rotational, or twisting, force. The surgery is used to fix fractures in the arms and legs, including bones in the shoulder, elbow, wrist, hip, knee, and ankle. Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. You can learn more about how we ensure our content is accurate and current by reading our. ORIF is a two-part procedure. CPT code 28615 would be reported for the fixation of the dislocation. The subcutaneous tissue and skin were excised with a No. The hand surgeon submitted two CPT codes, one for the metacarpal fracture and one for the distal radius fracture. Thanks for bring that to my attention PLASTICSCPT, I only went by the Cpt book and it does not address what type of bone donor, it only said, any donor, so after I read your message, I went on my Ingenix program and looked at the Lay terminology definition and saw Autograft. Avoiding Common Anesthesia Billing Pitfalls, It is important to note that two of these, Use these codes to report debridement of the skin and other sites when an open fracture or dislocation is present. These are considered to be follow-up care during the global period, unless the patient is returned to an approved operative suite. The first part is open reduction. If you have an arm fracture, you may go home later that day. Epidemiology Incidence Fractures of metacarpal shaft Metacarpal shaft fractures tend to angulate apex dorsal with the head displaced palmarly due to the deforming pull of the interossei muscles. xk~]A 'vZI|u The surgery is used to fix fractures in the arms and legs, including bones in the shoulder, elbow, wrist, hip, knee, and ankle. Meniscal repair and meniscectomy Open reduction and internal fixation (ORIF) surgery with plates and screws was performed and range of motion with hand therapy was begun early. Billing for hand procedures is among the most complex types of orthopaedic coding. In some instances, when bones can be easily manipulated to correct alignment, Closed Reduction and Internal Fixation may be done and no incision will be made in affected finger/hand. Perform gentle range of motion activities of the fingers. Screw Fixation. %PDF-1.5 Medical Therapy Most. Treatment ranges from splint immobilization for certain extra-articular fractures to surgical fixation for . Bennett Fractrue ORIF Contraindications. It is important to elevate your arm on a couple of pillows to alleviate pain and swelling. managing3. Open reduction internal fixation (orif) is a surgery to fix severely broken bones. You can use a knee scooter, seated scooter, or crutches. These moves will help you regain strength and movement in the area. Above mentioned codes only report debridement of open fractures and dislocations. Femur fracture open reduction and internal fixation. To ensure accurate reporting, report the surgical CPT codes according to the AMA CPT rules; apply payor rules appropriately based (e.g., Medicare NCCI payment rules are applied for Medicare Part B beneficiaries; private payor rules will vary based on contractual agreements). Metacarpal Neck Fracture ORIF Follow-up care. Splints for metacarpal neck or head fractures should be extended to include the MCP joint in an intrinsic-plus position. Open reduction and internal fixation of metacarpal fractures using a thermoplastic splint as a surgical instrument Open reduction and internal fixation of metacarpal fractures using a thermoplastic splint as a surgical instrument Arch Plast Surg. Fractures occurring in the outer bones of the foot are called 5th metatarsal fractures. The transscaphoid perilunar fracture dislocation is the most common of all perilunar displacements. internal fixation" is Subsequently the RVU's for fracture treatment codes havebeen decreased American Academy of Professional Coders corrected now Session 1A, 10-11:30 AM Friday, October 26th, 2012 Epicondylitis CPT 24357 - percutaneous elbow CPT 24359 - tenotomy elbow tenotomy, med. Fractures of the fifth metatarsal are common injuries that must be recognized and treated appropriately to avoid poor clinical outcomes for the patient. Depending on the nature of the fracture, the bones may be repositioned surgically or without surgery. synonyms:metacarpal shaft fracture ORIF, MC ORIF, MC shaft ORIF, metacarpal fixation, Metacarpal Shaft Fracture ORIF Indications, Metacarpal Shaft Fracture ORIF Contraindications, Metacarpal Shaft Fracture ORIF Alternatives, Metacarpal Shaft Fracture ORIF Pre-op Planning, Metacarpal Shaft Fracture ORIF Complications, Metacarpal Shaft Fracture ORIF Follow-up care, Metacarpal Shaft Fracture ORIF Review References, Site Terms | Copyright Information | ContactUs | Site Registration. Loading. 3 0 obj A. 2008-2023 eORIF LLC. Epub 2021 Jul 15. ;O^#v;3$%C"Nya8?_0?_|96c;q;Xoo_}W|{e!Uq,#JL[=C24KWxqwo^Y^n/fUjScW+`,+I \JHCuYu:HYx?`v2IV.FJwJ(%ASt& `&g The information on this website may not be complete or accurate. In the scenario presented, there is no overlap between the two anatomic fractures and both global fractures codes, for example, 25600 and 26600 (assuming these codes define the fracture) are reportable. Bennett fragment < 20% of the articular surface: CRPP. You may also need to repeat the surgery if the fracture doesnt heal properly. Phase 1- Early Protective Phase (0 weeks - 2 or 3 weeks) Goals for phase 1 Protect healing fracture and surgical fixation Reduce pain & edema ; Other considerations If multiple digits are involved, a forearm-based safe position splint . Open Reduction and Internal Fixation (ORIF). stream Base of Thumb metacarpal fractures can be extra-articular fractures, Bennett fractures (partial intra-articular), or Rolando fractures (complete intra-articular). The hand surgeon submitted two CPT codes, one for the metacarpal fracture and one for the distal radius fracture. Both fractures were non displaced and the hand surgeon applied a short arm cast. 23575 Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement) 2008-2023 eORIF LLC. ORIFF/CRPPsurgical and non-surgical approaches to resetting bones. Be sure to follow CPT coding rules and the AAOS Complete Global Service Data for Orthopaedic Surgery when reporting all services. The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care". Assess motion, consider occupational therapy if indicated. Dr. Hand reports one CPT code if this patient was Granny, who has Medicare Part B coverage. Your answer is correct if the payor is Medicare; the surgeons answer is correct if the payor follows CPT rules. JavaScript is disabled. It may also involve the surrounding neurovascular structures, ligaments, and/or tendons, or involve dead or devitalized tissue, hemorrhaging, or swelling. What is the cpt code for ORIF for right 5th metacarpal? (n.d.). Treatment is based on which metacarpal is involved, location of the fracture, and the rotation/angulation of the injury. Activity modifications: no heavy manual labor, no contact sports, no lifting >5 lbs. Each fracture that is evaluated and treated and meets a global fracture code is reportable assuming unbundling is not occurring. The type of hardware used depends on the location and type of fracture. Can you help clarify this scenario? Metacarpal shaft fracture (below). Closed reduction and percutaneous pinning is commonly used for low-energy metacarpal shaft and neck fractures (Figs. Dorsal longitudinal incision over affected metacarpal. The podiatrist reports the appropriate arthrodesis procedure code. IntroductionIt is generally accepted that severely displaced or malrotated neck fractures of the fifth metacarpal should be treated by closed reduction and pinning. AU - Kadakia, Anish R. AU - Myerson, Mark S . There are many types of skull fractures, but only one major cause. If plates and screws require removal in the future, this will require an additional surgery. Our new hand surgeon evaluated a patient with a base of the fifth metacarpal fracture and distal radius fracture. Resource Type: 15 blades to bleeding tissue. Open fractures are those in which the bone and/or joint is exposed to the external environment or a fracture or dislocation caused by a blunt or penetrating force sufficient to disrupt or penetrate skin layers, subcutaneous tissue, muscle fascia/muscle, and bones or joints. 26650. Fracture coding submenus; Hand Surgery CPT Codes, sorted by number; Extraarticular Metacarpal Fx CPT Codes; Metacarpal Injuries: Open Treatment CPT Codes . Fracture management starts with an appreciation of the normal architecture of the hand; fluency with the names and locations of the bones; and comprehension of how the normal extrinsic and intrinsic muscle forces, after fracture, challenge a less than stable skeleton. In total, 25 patients with unstable fractures at the base of the first metacarpal underwent closed reduction and percutaneous fixation of the fracture. It is not intended for the general public. The countdown to AAOS 2023 March 7-11 in Las Vegas is on! While showering, it is important you do not use your hand/arm. See Site Terms / Full Disclaimer. Its only used for serious fractures that cant be treated with a cast or splint. describe the steps of the procedure verbally prior to the start of the case 2. Bone fracture repair is a surgery to fix a broken bone using metal screws, pins, rods, or plates to hold the bone in place. The surgeon is correct according to CPT rules. Bennett Fractrue ORIF Indications. Open reduction internal fixation (ORIF) is a surgical approach that's used for repairing certain types of bone fractures. CPT codes 11010, 11011, and 11012 were revised to describe debridement at the site of an open fracture including removal of foreign material. After pin removal, you will be referred for Occupational Therapy of the affected hand and wrist. 12 ICD-9-CM Fracture Coding Late effects of fractures are reported using a fracture code indexed under the entry "Late" While the information on this site is about health care issues and sports medicine, it is not medical advice. Open reduction internal fixation (ORIF) is a surgery to fix severely broken bones. "American Academy of Orthopaedic Surgeons" and its associated seal and "American Association of Orthopaedic Surgeons" and its logo are all registered U.S. trademarks and may not be used without written permission. . Metacarpal Fractures and Dislocations Treatment & Management Updated: Jan 19, 2023 Author: James Neal Long, MD, FACS; Chief Editor: Joseph A Molnar, MD, PhD, FACS more. 28485 Open treatment of metatarsal fracture, includes internal fixation. Metacarpal Fractures Pathway Updated: 10/4/2016. Who is right? . <> Medicare payment rules are specific to payments and occasionally require the use of a different code when reporting services. They should not be used to report minor debridement or the normal care that would be taken with an open fracture, such as minor excision of the wound edges (skin margin) necessary to close the defect. Learn how to, Most people recover from a broken wrist in a few months, but sometimes complications can occur. Intraarticular fracture of the metacarpophalangeal (MP) joint presents complex problems related to the sophisticated functional aspects of the hand. Encourage gentle ROM. Metacarpal DCP Plating for Transverse Fracture, Metacarpal Fracture Closed Reduction and Pinning, Metacarpal Neutralization Plate with Lag Screw Fixation for Short Oblique Fracture, Surgical Excision of Dorsal Ganglion Cyst, concomitant and associated orthopaedic injuries, differential diagnosis and physical exam tests, documents failure of nonoperative management, describes accepted indications and contraindications for surgical intervention, diagnose and management of early complications, describe complications of surgery including, MCP or interphalangeal capsular contractures, describe the steps of the procedure verbally prior to the start of the case, patient placed in the supine position with hand on hand table, place tourniquet high on the affected extremity, make a longitudinal or curvilinear incision over the metacarpal head, this will facilitate the exposure of the fracture, use a dental pick or small pointed reduction forceps to reduce the fracture, insert guidewires from a cannulated headless screw set, insert headless screws over the guidewires, check the screw placement and fracture reduction radiographically, close the periosteum and the interosseous muscle fascia over the plate, this provides a smooth gliding surface for the extensor mechanism, close the extensor mechanism with 4-0 nonabsorbable suture, schedule follow up appointment in 2 weeks. You dont need ORIF if you have a minor fracture. Once your bones begin to heal, your doctor may have you do physical or occupational therapy. CPT Coding. The bone utilized for the case in question is an allograft. A splint was applied after the ORIF procedure to stabilize both fractures. registered for member area and forum access. * : Reduction Of Fracture And Dislocation. The open fracture of the femur is 27269, and the debridement would be 11010, along with a -59 modifier to bypass any edit. Description of potential complications and steps to avoid them . A: VEPTR stands for vertical expandable prosthetic titanium rib. It is used to treat thoracic insufficiency syndrome, a congenital condition in which severe deformities of the chest, spine, and ribs prevent normal breathing and lung growth and development. We are catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The information on this website may not be complete or accurate. Ensure screw purchase in 4 cortices (2 plate holes) on both sides of the fracture, Consider cancellous bone graft from proximal ipsilateral ulna, distal radius, or iliac crest if needed. Absolute stability is achieved using compression plate principles. For a better experience, please enable JavaScript in your browser before proceeding. Often the wound site is contaminated with foreign material (e.g., grass, twigs, dirt, oil, grass, gravel, etc) and bacteria. Finally, the surgeon will close the incision with stitches or staples, apply a bandage, and may put the limb in a cast or splint depending on the location and type of fracture. Open reduction means a surgeon makes an incision to re-align the bone. For that, you will require modifiers (-51, -58, -78). Diagnosis is made by orthogonal radiographs the hand. Open Reduction Of Fracture With Internal Fixation, Carpals And Metacarpals. <>>> no bath tubs, swimming pools, washing dishes, etc.). 2005-2023 Healthline Media a Red Ventures Company. S62.336A- Displaced fracture of neck of fifth metacarpal bone, right hand, initial encounter for closed fracture. See answer (1) Copy. Q: The pediatric spine surgeons perform a procedure they call VEPTR. From the operative note, it appears that they are placing instrumentation only without any associated fusion. (n.d.). For the debridement of an open fracture includes only skin and subcutaneous tissue, use code 11010; debridement down to the muscle fascia and muscle, code 11011; and debridement that includes skin, muscle fascia, muscle, and bone, code 11012. Postoperative period services These fractures tend to be unstable and if they are displaced or multiple (as in the picture below) surgery will be recommended. Question: 35-1 and 35-2 ). KarenZupko & Associates, Inc. | 312.642.5616 | information@karenzupko.com. See all Metatarsal fracture CPT codes. Its only used for serious fractures that cannot be treated with a cast or splint. When multiple injuries occur, it may be necessary for the physician to perform multiple procedures to restore lost functioning. For a smooth recovery, heres what you can do at home: Its important to attend all your checkups after surgery. Encourage gentle ROM. The goal of the metatarsal fracture fixation (open reduction and internal fixation) procedure is to correct a fracture of one or more of the long bones of the foot, called the metatarsus. 28485 Open treatment of metatarsal fracture, includes internal fixation. Pre-operative antibiotics, +/- regional block. [ 3, 4] In the United States, upper-extremity injuries result in over 16 million days off of work and a further 90 million days of restricted activity. Intramedullary Screw Fixation for Metacarpal Fractures.