CPT® Code 25335

The procedure described by CPT® Code 25335 refers to the centralization of the wrist on the ulna, specifically in cases such as radial club hand. Radial club hand is a congenital deformity characterized by an abnormality in the forearm and wrist, where the radius may be partially or completely absent, leading to a range of severity in the condition. In some instances, the radius may be present but significantly shorter and smaller than normal. This condition can also involve the absence of the thumb and various deformities affecting the fingers, elbow joint, and soft tissues of the forearm. The severity of radial club hand is influenced by the presence of a fibrous tissue structure known as an anlage, which connects the shortened radius to the carpal bones. The growth potential of this fibrous tissue is limited, and if an anlage is present, it can cause the hand to bend or club toward the radial side of the arm as the ulna grows during fetal development. The surgical procedure involves making a dorsal longitudinal incision over the radial aspect of the wrist and forearm to expose the carpal bones and ulna. The surgeon then excises bone from the distal ulna, squares off the distal ulna, and removes one or more carpal bones to facilitate the proper positioning of the hand over the ulna. A rectangular notch is created in one of the remaining carpal bones, into which the squared-off ulna is inserted, and internal fixation may be applied to secure the ulna in place. Finally, the surgical wound is closed in layers, and the wrist is immobilized in a cast to promote healing.