CPT® Code 24470

1. Indications

Hemiepiphyseal arrest is indicated for the treatment of specific angulation deformities at the elbow, particularly in pediatric patients. The following conditions warrant this procedure:

• Cubitus Varus - This condition causes the forearm to deviate toward the midline of the body, leading to a characteristic appearance and potential functional limitations.
• Cubitus Valgus - In contrast, cubitus valgus results in the forearm deviating away from the midline, which can also affect the function and alignment of the elbow joint.

2. Procedure

The procedure for hemiepiphyseal arrest involves several critical steps to ensure effective treatment of the angulation deformity:

• Step 1: Incision - The surgeon begins by making an incision over the distal aspect of the humerus, extending down over the elbow joint. This incision provides access to the underlying structures while minimizing damage to surrounding tissues.
• Step 2: Dissection - Following the incision, soft tissues are carefully dissected to expose the distal humerus. During this step, great care is taken to protect vital blood vessels and nerves that are located in the vicinity of the elbow joint.
• Step 3: Exposure of the Distal Humerus - Once the soft tissues are adequately dissected, the distal humerus is fully exposed, allowing the surgeon to visualize the growth plate and plan for the placement of the corrective devices.
• Step 4: Placement of Devices - The surgeon then strategically places Blount staples, transphyseal screws, or a plate and screw device into the epiphysis of the distal humerus. These devices are designed to temporarily arrest growth in that specific region of the bone, effectively halting further development that contributes to the deformity.
• Step 5: Preservation of Growth - Importantly, the other portion of the epiphysis is left untreated, allowing for continued growth in that area. This selective arrest of growth is crucial for gradually diminishing or correcting the angulation deformity over time.

3. Post-Procedure

After the hemiepiphyseal arrest procedure, patients typically require careful monitoring and follow-up care. Post-operative care may include pain management, immobilization of the elbow joint to promote healing, and regular assessments to monitor the correction of the deformity. The expected recovery period varies depending on the individual patient's healing process and the extent of the procedure performed. It is essential for healthcare providers to educate patients and their families about the importance of follow-up visits to ensure proper alignment and function of the elbow as the child continues to grow.