CPT® Code 25431

Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each bone

The procedure described by CPT® Code 25431 pertains to the surgical repair of a nonunion of a carpal bone, specifically excluding the carpal scaphoid (navicular). A nonunion occurs when the fracture fragments fail to heal together after an adequate period, leading to persistent instability and pain in the wrist. This surgical intervention involves a detailed approach where an incision is made on the posterior side of the wrist to access the affected carpal bone. The extensor tendons are carefully retracted to provide a clear view of the wrist capsule, which is then incised to expose the original fracture site. The surgeon evaluates the nonunion to determine the necessary repair technique. The procedure includes debridement of the fracture site to remove any scar tissue, ensuring that healthy cancellous bone is exposed for optimal healing. A local bone graft is typically harvested from the radius, which involves making a separate incision over the radius, elevating the periosteum, and creating a cortical window to access and collect cancellous bone. This harvested bone graft is then shaped or morcellized to fit the defect in the carpal bone. To secure the graft and stabilize the carpal bone fragments, internal fixation methods such as pins or wires may be employed. It is important to note that this code is applicable for each carpal bone repaired, excluding the scaphoid (navicular).