CPT® Code 25450

1. Indications

The procedure of epiphyseal arrest by epiphysiodesis or stapling is indicated for specific orthopedic conditions that affect the growth and alignment of the forearm bones. The following are the primary indications for this procedure:

• Angulation Deformity: This condition occurs when the wrist exhibits a noticeable bend or curve due to abnormal growth patterns in the radius or ulna. The procedure aims to correct this deformity by selectively arresting growth in the affected epiphysis.
• Bone Length Discrepancy: This situation arises when there is a significant difference in length between the radius and ulna, which can lead to functional impairment and aesthetic concerns. The procedure is performed to arrest growth in the entire epiphysis of the affected bone to equalize the lengths of the radius and ulna.

2. Procedure

The surgical procedure for epiphyseal arrest involves several critical steps to ensure effective treatment. The following outlines the procedural steps as described:

• Step 1: Incision and Exposure An incision is made over the distal aspect of the radius and/or ulna, extending down to the wrist joint. This incision allows access to the underlying structures while minimizing damage to surrounding tissues.
• Step 2: Dissection of Soft Tissues The surgeon carefully dissects the soft tissues surrounding the radius and ulna, taking special care to protect vital blood vessels and nerves that are located in this area. This step is crucial to prevent complications during the procedure.
• Step 3: Exposure of the Distal Radius and/or Ulna Once the soft tissues are adequately dissected, the distal radius and/or ulna are exposed. This exposure is necessary for the placement of the devices that will arrest growth.
• Step 4: Placement of Growth Arrest Devices The surgeon strategically places Blount staples, transphyseal screws, or a plate and screw device into the epiphysis of the distal radius or ulna. The choice of device depends on the specific needs of the patient and the nature of the deformity or discrepancy being treated.
• Step 5: Partial or Complete Arrest If the procedure is aimed at correcting an angulation deformity, only a portion of the epiphysis is arrested, allowing the untreated portion to continue growing and gradually correct the deformity. In cases of bone length discrepancy, the entire epiphysis is arrested to prevent further growth and equalize the lengths of the bones.

3. Post-Procedure

After the epiphyseal arrest procedure, patients typically require careful monitoring and follow-up care to ensure proper healing and assess the effectiveness of the treatment. Post-procedure care may include pain management, immobilization of the wrist and forearm to promote healing, and physical therapy to restore function. Patients are advised to follow their surgeon's instructions regarding activity restrictions and rehabilitation exercises. Regular follow-up appointments are essential to monitor bone growth and alignment, as well as to address any potential complications that may arise during the recovery process.