CPT® Code 25375

1. Indications

The procedure of multiple osteotomies with realignment on an intramedullary rod is indicated for various conditions affecting the radius and ulna. These indications may include:

• Deformity Correction - The procedure is performed to correct deformities in the radius and/or ulna, which may arise from congenital issues, trauma, or other pathological conditions.
• Bone Malalignment - It is indicated for cases where the bones are misaligned, leading to functional impairment or aesthetic concerns.
• Post-Traumatic Deformities - Patients who have sustained fractures or injuries that have healed improperly may require this procedure to restore normal bone structure and function.

2. Procedure

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

• Incision and Exposure - A longitudinal incision is made over the forearm to provide access to the radius and ulna. The soft tissues are carefully dissected to expose the bones, allowing the surgeon to work directly on the affected areas.
• Periosteum Elevation - Once the bones are exposed, the periosteum is elevated to facilitate access to the bone surface, which is essential for performing the osteotomies.
• Bone Cutting - Using a drill, saw, and/or osteotome, the surgeon makes precise cuts in the radius and/or ulna according to the predetermined configuration based on the deformity. The type of osteotomy performed will depend on the specific requirements of the case.
• Intramedullary Rod Selection - After the osteotomies are completed, the radius and/or ulna are sized, and an appropriately sized intramedullary rod is selected to provide internal stabilization.
• Drilling the Canal - A drill hole is created in either the distal or proximal aspect of the radius and/or ulna. The intramedullary canal is then drilled or reamed through this hole to prepare for the insertion of the rod.
• Guidewire Placement (if applicable) - If a cannulated rod is being used, a guidewire is placed into the intramedullary canal to assist in the accurate positioning of the rod.
• Rod Insertion - The intramedullary rod is advanced over the guidewire until it is properly positioned within the canal, ensuring that it aligns with the anatomical structure of the bones.
• Securing the Rod - Finally, the bone is anatomically positioned at each osteotomy site, and the rod is secured using screws, pins, or other fixation devices to maintain stability and promote healing.

3. Post-Procedure

Post-procedure care following multiple osteotomies with intramedullary rod placement typically involves monitoring for complications, managing pain, and ensuring proper healing. Patients may be advised to limit movement of the forearm to allow for adequate recovery. Follow-up appointments are essential to assess the alignment of the bones and the integrity of the fixation. Rehabilitation may include physical therapy to restore function and strength in the forearm as healing progresses. The duration of recovery can vary based on the individual patient's condition and the extent of the surgery performed.