CPT® Code 25370

1. Indications

Multiple osteotomies of the radius and/or ulna are indicated for various conditions that necessitate realignment of the forearm bones. The following are common indications for this procedure:

• Deformity Correction - This procedure is performed to correct congenital or acquired deformities of the radius and/or ulna.
• Fracture Malunion - It is indicated in cases where fractures of the radius or ulna have healed improperly, leading to functional impairment.
• Post-Traumatic Deformities - Patients with deformities resulting from trauma may require osteotomies to restore normal bone alignment.
• Osteoarthritis - In some cases, osteotomies may be performed to alleviate pain and improve function in patients with osteoarthritis affecting the forearm.

2. Procedure

The procedure for multiple osteotomies with realignment on an intramedullary rod involves several critical steps:

• Step 1: Preoperative Planning - Prior to the surgical procedure, the physician conducts radiographic studies to determine the precise locations for the osteotomies. This planning is essential to ensure that the cuts made will effectively correct the deformity.
• Step 2: Incision and Exposure - A longitudinal incision is made over the forearm to access the radius and/or ulna. The soft tissues are carefully dissected to expose the bone, allowing for a clear surgical field.
• Step 3: Elevation of the Periosteum - The periosteum, which is the fibrous tissue covering the bone, is elevated to facilitate access to the bone for the osteotomy.
• Step 4: Bone Cutting - Using a drill, saw, and/or osteotome, the bone is cut according to the pre-determined configuration. The specific type of osteotomy performed will depend on the nature of the deformity being corrected.
• Step 5: Rod Selection and Insertion - After the osteotomies are completed, the radius and/or ulna is sized, and an appropriately sized intramedullary rod is selected. A drill hole is created in either the distal or proximal aspect of the bone.
• Step 6: Drilling the Intramedullary Canal - The intramedullary canal is drilled or reamed through the previously created drill hole to prepare for the rod insertion.
• Step 7: Guidewire Placement (if applicable) - If a cannulated rod is used, a guidewire is placed into the intramedullary canal to facilitate the rod's advancement.
• Step 8: Rod Positioning - The intramedullary rod is advanced over the guidewire until it is properly positioned within the canal, ensuring stability and alignment of the bones.
• Step 9: Securing the Rod - The bone is anatomically positioned at each osteotomy site, and the rod is secured using screws, pins, or other fixation devices to maintain the desired alignment during the healing process.

3. Post-Procedure

After the completion of the multiple osteotomies and the insertion of the intramedullary rod, post-procedure care is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or improper alignment. Pain management strategies are implemented to ensure patient comfort. Rehabilitation may be initiated to restore function and strength in the forearm, with physical therapy tailored to the individual’s needs. Follow-up appointments are scheduled to assess healing and to ensure that the bones are properly aligned and stable. The expected recovery time may vary based on the extent of the procedure and the individual patient's healing response.