CPT® Code 27519

1. Indications

The open treatment of distal femoral epiphyseal separation, as described by CPT® Code 27519, is indicated for specific conditions and injuries that affect the growth plate of the femur. The following are the primary indications for this procedure:

• Distal Femoral Epiphyseal Separation This condition involves the separation of the growth plate from the femur, typically due to trauma, which can lead to complications if not treated.
• Salter-Harris Fracture This type of fracture specifically affects the growth plate and is classified based on the involvement of the epiphysis and metaphysis, necessitating surgical intervention to prevent growth disturbances.
• Trauma to the Growth Plate Any significant trauma that results in injury to the growth plate may require surgical treatment to restore proper alignment and function.

2. Procedure

The procedure for the open treatment of distal femoral epiphyseal separation involves several critical steps to ensure proper alignment and stabilization of the fracture. The following outlines the procedural steps:

• Step 1: Incision An incision is made over the lateral aspect of the knee to provide access to the affected area. This initial step is crucial for allowing the surgeon to reach the growth plate directly.
• Step 2: Dissection The dissection is carried down to the fascia lata, which is then split to facilitate further access. The vastus lateralis muscle is elevated to expose the underlying structures, ensuring that the surgical team can visualize the growth plate and fracture fragments.
• Step 3: Exposure of Fracture Fragments Careful dissection around the growth plate is performed to expose the fracture fragments. This step requires precision to avoid causing additional injury to the growth plate, which is vital for future bone growth.
• Step 4: Anatomic Alignment The surgeon restores anatomic alignment of the fracture fragments through direct visualization and careful manipulation. This is a critical step to ensure that the growth plate remains intact and functional.
• Step 5: Internal Fixation Once anatomic reduction is achieved, the fracture fragments are secured with internal fixation. Initially, wire fixation may be temporarily placed to hold the fragments in position while alignment is checked radiographically.
• Step 6: Permanent Fixation After confirming proper alignment through imaging, permanent fixation is applied using screws and/or pins to stabilize the fracture. This ensures that the fragments remain in place during the healing process.
• Step 7: Verification and Closure Anatomic reduction is again verified radiographically to confirm the stability of the fixation. Following this, the soft tissue is reapproximated, and the wound is closed to complete the procedure.

3. Post-Procedure

Post-procedure care for patients undergoing open treatment of distal femoral epiphyseal separation includes monitoring for complications and ensuring proper healing. Patients may require follow-up imaging to assess the alignment and stability of the fixation. Rehabilitation may be necessary to restore function and strength in the affected leg. The recovery process will vary based on the individual patient's condition and the extent of the injury, but careful adherence to post-operative instructions is essential for optimal outcomes.