CPT® Code 27727

1. Indications

The procedure coded as CPT® 27727 is indicated for the treatment of congenital pseudarthrosis of the tibia. This condition typically presents with the following characteristics:

• Congenital Pseudarthrosis A rare condition where there is a defect in the tibia that may be cystic, sclerotic, or dysplastic, leading to abnormal movement at the site.
• Bone Defect The presence of a bony defect in the tibia that may result in instability and deformity, affecting the patient's mobility.
• Anterolateral Movement The tibia may exhibit abnormal movement or bowing, which can lead to functional impairment.

2. Procedure

The surgical procedure for the repair of congenital pseudarthrosis of the tibia involves several critical steps, which are detailed as follows:

• Step 1: Incision A skin incision is made directly over the area of the tibial defect. This incision allows access to the underlying structures and is carefully planned to minimize damage to surrounding tissues.
• Step 2: Dissection The soft tissues surrounding the tibia are meticulously dissected to expose the bone defect. This step is crucial for ensuring that the surgeon has a clear view of the area that requires repair.
• Step 3: Excision of Bone Lesion The bone lesion is excised, which involves removing the defective portion of the tibia. This step is essential to prepare the site for the subsequent repair techniques.
• Step 4: Repair Techniques Various repair techniques may be employed depending on the specific characteristics of the defect. These techniques can include the placement of a compression device, a vascularized free fibular graft, autogenous bone grafting, or intramedullary rodding. The choice of technique is based on the surgeon's assessment of the defect and the best approach for stabilization and healing.
• Step 5: Closure After the repair is completed, the incisions are closed in layers. This layered closure technique is important for promoting optimal healing and minimizing complications.
• Step 6: Immobilization Following the closure of the incisions, a cast or splint is applied as needed to immobilize the leg. This immobilization is critical for ensuring that the repaired area remains stable during the initial healing phase.

3. Post-Procedure

Post-procedure care following the repair of congenital pseudarthrosis of the tibia typically involves monitoring for signs of healing and potential complications. Patients may be advised to keep the leg elevated and to follow specific weight-bearing restrictions as determined by the surgeon. Regular follow-up appointments are essential to assess the healing process and to make any necessary adjustments to the treatment plan. The application of a cast or splint will generally remain in place for a specified duration to ensure proper immobilization and support during recovery. Rehabilitation may be recommended to restore function and strength to the affected leg once the initial healing has occurred.