CPT® Code 25335

1. Indications

The centralization of the wrist on the ulna, as described by CPT® Code 25335, is indicated for the treatment of congenital deformities such as radial club hand. This procedure is performed in cases where there is a significant deformity of the forearm and wrist, which may include:

• Radial Club Hand A congenital condition characterized by the absence or underdevelopment of the radius, leading to a range of functional and aesthetic issues in the hand and wrist.
• Severe Deformities Conditions that may involve the absence of the thumb, deformities of the fingers, and abnormalities in the elbow joint and soft tissues of the forearm.
• Presence of an Anlage Situations where a fibrous tissue connection exists between the shortened radius and the carpal bones, which can affect the positioning of the hand as the ulna grows.

2. Procedure

The procedure for centralization of the wrist on the ulna involves several critical steps to correct the deformity and restore function. The steps are as follows:

• Dorsal Longitudinal Incision A dorsal longitudinal incision is made over the radial aspect of the wrist and forearm to provide access to the underlying structures. This incision allows the surgeon to expose the carpal bones and the ulna for further manipulation.
• Exposure of Carpal Bones and Ulna Once the incision is made, the surgeon carefully dissects the tissue to expose the carpal bones and the distal ulna. This exposure is crucial for the subsequent steps of the procedure.
• Bone Excision and Squaring of Distal Ulna The surgeon excises bone from the distal ulna to facilitate proper alignment and positioning. The distal ulna is then squared off to create a flat surface that will interface with the carpal bones.
• Removal of Carpal Bones One or more carpal bones are removed as necessary to allow the hand to be positioned directly over the ulna. This step is essential for achieving the desired anatomical alignment.
• Creation of Rectangular Notch A rectangular notch is created in one of the remaining carpal bones. This notch is designed to accommodate the squared-off distal ulna, allowing for a stable connection.
• Insertion of Distal Ulna The squared-off distal ulna is inserted into the rectangular notch created in the carpal bone. This step is critical for ensuring that the ulna is properly aligned with the wrist.
• Internal Fixation Internal fixation may be applied as needed to secure the ulna to the carpal bone. This fixation helps maintain the position of the ulna during the healing process.
• Closure of Surgical Wound After the necessary adjustments and fixations are made, the surgical wound is closed in layers to promote optimal healing and minimize complications.
• Immobilization in a Cast Finally, the wrist is immobilized in a cast to provide support and stability during the recovery period, allowing for proper healing of the surgical site.

3. Post-Procedure

Post-procedure care following the centralization of the wrist on the ulna involves monitoring the surgical site for signs of infection and ensuring that the cast remains intact. Patients are typically advised to keep the cast dry and to avoid putting weight or pressure on the affected wrist. Follow-up appointments are essential to assess healing and to determine when physical therapy may begin to restore function and mobility. The duration of immobilization in the cast may vary based on the individual case and the surgeon's recommendations, but it is crucial for promoting proper alignment and recovery of the wrist and hand.