CPT® Code 25491

1. Indications

The prophylactic treatment of the ulna using CPT® Code 25491 is indicated for patients who exhibit weakened bone integrity due to various underlying conditions. The following are specific indications for this procedure:

• Bone Weakness Due to Disease The procedure is performed when the ulna is compromised as a result of diseases such as osteoporosis, which leads to decreased bone density and increased fracture risk.
• Bone Weakness Due to Neoplasm Patients with bone tumors or malignancies that affect the ulna may require prophylactic treatment to prevent fractures associated with the weakened bone structure.

2. Procedure

The procedure for prophylactic treatment of the ulna involves several critical steps, each designed to ensure the stability and integrity of the bone. The following outlines the procedural steps:

• Step 1: Radiographic Evaluation Prior to the surgical intervention, a thorough radiographic evaluation is conducted to assess the condition of the ulna. This imaging helps determine the extent of bone weakness and guides the selection of the most appropriate prophylactic method.
• Step 2: Incision An incision is made over the proximal or distal ulna, providing access to the bone. The location of the incision is determined based on the specific area of weakness identified during the radiographic evaluation.
• Step 3: Insertion of Prophylactic Device Depending on the chosen method, an intramedullary nail or rod may be inserted into the intramedullary space of the ulna. This can be done using either an antegrade approach, where the device is inserted from the distal end, or a retrograde approach, where it is inserted from the proximal end.
• Step 4: Securing the Device Once the nail or rod is in place, it is secured using locking screws that are placed distally and proximally to ensure stability. If pins are utilized instead, they may be placed transcutaneously through the weakened area of the ulna.
• Step 5: Plating or Wiring (if applicable) In cases where plating is indicated, an open exposure of the ulna is performed, and a plate is affixed to the bone using screws. Alternatively, wiring may be employed, which involves wrapping a wire cerclage around the ulna to provide additional support.
• Step 6: Use of Methylmethacrylate (if indicated) If deemed necessary, methylmethacrylate may be injected into any bony defects to further enhance the stability of the ulna and prevent future fractures.

3. Post-Procedure

After the prophylactic treatment of the ulna, patients are typically monitored for any immediate complications. Post-procedure care may include pain management, immobilization of the arm to allow for proper healing, and follow-up radiographic evaluations to ensure the stability of the treatment. Patients are advised on rehabilitation exercises to restore function and strength to the affected area, and they may require physical therapy as part of their recovery process. The expected recovery time can vary based on the individual patient's condition and the extent of the procedure performed.