CPT® Code 25420

The CPT® Code 25420 refers to the surgical procedure for the repair of a nonunion or malunion of both the radius and ulna, which involves the use of an autograft. A nonunion occurs when the fracture fragments fail to heal together after an adequate period, while a malunion refers to the improper alignment of the fracture fragments, leading to potential complications such as osseous abnormalities, incongruity of articular surfaces, soft tissue contracture, and nerve impingement. During this procedure, the original fracture sites of the radius and ulna are surgically exposed to assess the condition of the nonunion or malunion. The evaluation determines the necessary repair approach, which may involve internal fixation techniques, with or without the addition of a bone graft. In cases where internal fixation is performed without a graft, a compression plate may be utilized to stabilize the fracture. For nonunions, a compression plate is applied over the fracture site and secured with lag screws, while malunions may require refracturing and realignment of the radius and ulna, followed by internal fixation to maintain proper anatomical alignment. If a bone graft is indicated, the site is prepared, which may involve refracturing the bone to facilitate healing. An autograft is typically harvested from the iliac crest, where a skin incision is made, and muscle is stripped to expose the bone surface for harvesting cortical and/or cancellous bone. The harvested bone is then shaped to fit the defect, or cancellous bone may be morcellized and packed into the defect. Internal fixation devices, such as pins or wires, may be used to secure the graft, and a compression plate along with screws or other fixation methods is employed to stabilize the fracture effectively.