CPT® Code 25426

1. Indications

The procedure described by CPT® Code 25426 is indicated for the repair of bone defects in the radius and ulna that are not due to a nonunion or malunion of a fracture. This means that the procedure is performed when there is a defect in the bone structure that has not resulted from improper healing of a previous fracture. The indications for this procedure may include:

• Bone Defect A defect in the bone structure of the radius and ulna that requires surgical intervention for repair.
• Nonunion or Malunion Exclusion The defect must not be a result of a nonunion (failure of the bone to heal) or malunion (healing in an incorrect position) of a fracture.

2. Procedure

The procedure for repairing a defect in both the radius and ulna using an autograft involves several critical steps, which are detailed as follows:

• Preparation of the Defect Site The surgical process begins with the careful preparation of the site where the bone defect is located. This involves assessing the extent of the defect and ensuring that the surrounding tissue is healthy enough to support the graft.
• Harvesting the Autograft An autograft is typically harvested from the iliac crest, which is a common donor site. A skin incision is made over the iliac crest, and the muscle is stripped away to expose the bone surface. The surgeon then collects either cortical bone, which is dense and forms the outer layer of bone, or cancellous bone, which is spongy and found within the bone.
• Shaping the Graft Once the bone is harvested, it is configured to match the size and shape of the defect in the radius and ulna. In some cases, cancellous bone may be morcellized, which means it is broken down into smaller pieces and packed into the defect to promote healing.
• Securing the Graft To ensure that the bone graft remains stable and properly integrated, internal fixation methods such as pins or wires may be used. This step is crucial for maintaining the position of the graft during the healing process.
• Stabilization of the Bone Finally, a compression plate and screws or other forms of internal fixation are applied to stabilize the bone. This stabilization is essential for the successful healing of the graft and the restoration of function to the radius and ulna.

3. Post-Procedure

After the completion of the procedure, post-operative care is essential for ensuring proper healing and recovery. Patients may be monitored for any signs of complications, such as infection or graft failure. Pain management strategies will be implemented to ensure patient comfort. Rehabilitation may be necessary to restore function and strength to the affected arm, and physical therapy may be recommended to aid in recovery. Follow-up appointments will be scheduled to assess the healing process and to ensure that the bone graft is integrating properly with the surrounding bone tissue.