CPT® Code 25431

1. Indications

The procedure described by CPT® Code 25431 is indicated for patients who have experienced a nonunion of a carpal bone, excluding the scaphoid (navicular). This condition typically arises when a fracture fails to heal properly after an adequate healing period, leading to ongoing pain, instability, and dysfunction in the wrist. The indications for this surgical intervention may include:

• Nonunion of Carpal Bone: A fracture that has not healed after a sufficient time, resulting in persistent symptoms.
• Wrist Pain: Chronic pain in the wrist that is associated with the nonunion, affecting the patient's quality of life.
• Functional Impairment: Difficulty in performing daily activities due to instability or pain in the wrist.

2. Procedure

The surgical procedure for CPT® Code 25431 involves several critical steps to effectively repair the nonunion of the carpal bone. The steps are as follows:

• Step 1: Incision and Exposure An incision is made over the posterior aspect of the wrist to access the affected carpal bone. The extensor tendons are carefully retracted to allow for a clear view of the wrist capsule, which is then incised to expose the original fracture site.
• Step 2: Evaluation of Nonunion Once the fracture site is exposed, the surgeon evaluates the nonunion to determine the appropriate repair technique required for the specific case.
• Step 3: Debridement The fracture site is cleared of any scar tissue, and the carpal bone is debrided until healthy cancellous bone is visible, ensuring a suitable environment for healing.
• Step 4: Harvesting Bone Graft A local bone graft is harvested, typically from the radius. This involves making a separate skin incision over the radius, elevating the periosteum, and creating a cortical window to access and collect cancellous bone.
• Step 5: Graft Preparation The harvested bone graft is then configured to match the size and shape of the defect in the carpal bone or morcellized and packed into the defect to promote healing.
• Step 6: Internal Fixation Internal fixation methods, such as pins or wires, are utilized as necessary to secure the bone graft and stabilize the carpal bone fragments, ensuring proper alignment and support during the healing process.

3. Post-Procedure

After the surgical repair of the nonunion of the carpal bone, patients can expect a recovery period that may involve immobilization of the wrist to allow for proper healing. Post-procedure care typically includes monitoring for signs of infection, managing pain, and following up with physical therapy to restore function and strength in the wrist. The duration of recovery may vary based on individual healing rates and the extent of the procedure performed. Patients are advised to adhere to their surgeon's postoperative instructions to optimize recovery outcomes.