CPT® Code 25393

1. Indications

The procedure described by CPT® Code 25393 is indicated for patients requiring lengthening of the radius and ulna due to various conditions. These may include:

• Congenital deformities - Conditions present at birth that affect the normal growth and development of the radius and ulna.
• Trauma - Injuries that result in bone shortening or malalignment, necessitating surgical intervention to restore proper length and function.
• Bone loss - Situations where there is a significant loss of bone mass due to disease, infection, or previous surgical procedures, requiring reconstruction to achieve normal bone length.
• Malunion or nonunion - Instances where previously fractured bones have healed improperly, leading to functional impairment and the need for corrective surgery.

2. Procedure

The procedure for CPT® Code 25393 involves several critical steps to achieve the desired lengthening of the radius and ulna:

• Step 1: Preoperative Planning - Prior to the surgical procedure, the physician conducts radiographic studies to identify the precise locations for the bone cuts. This planning is essential to ensure that the lengthening is performed accurately and effectively.
• Step 2: Exposure of the Bones - The surgeon makes an incision to expose the radius and ulna, providing access to the bones for the surgical intervention.
• Step 3: Bone Cuts - Cuts are made in both the radius and ulna. The surgeon carefully distracts the bones to create the necessary space for the autograft.
• Step 4: Harvesting the Autograft - An autograft is harvested from the iliac crest. This involves making a skin incision over the iliac crest, stripping the muscle to expose the bone surface, and then removing cortical and/or cancellous bone as needed.
• Step 5: Preparing the Graft - The harvested bone is shaped to the desired size and configuration. Cancellous bone may also be morcellized and packed into the defects created by the distraction of the radius and ulna.
• Step 6: Fixation - The surgeon applies internal fixation devices, such as pins, screws, or plates, to secure the cut edges of both bones in anatomical alignment. Alternatively, an external fixation device may be utilized to stabilize the bones externally.

3. Post-Procedure

After the completion of the osteoplasty procedure, patients typically require careful monitoring and follow-up care. Post-operative care may include pain management, physical therapy to restore function, and regular imaging studies to assess the healing process. The expected recovery time can vary based on individual patient factors and the extent of the procedure performed. Patients are advised to follow their surgeon's instructions regarding activity restrictions and rehabilitation to ensure optimal recovery and successful outcomes.