CPT® Code 26434

The procedure described by CPT® Code 26434 involves the surgical repair of the extensor tendon at its distal insertion, utilizing a free graft. This type of injury often results in a condition known as mallet finger, characterized by the inability to straighten the affected finger due to a flexion deformity at the distal interphalangeal joint. Such injuries typically occur from a blunt force impact to the fingertip, leading to a tear or rupture of the tendon. In some instances, the injury may also involve a fragment of bone being avulsed along with the tendon. The timing of the repair is critical; primary repairs are generally conducted within 24 hours post-injury, while secondary repairs are indicated for cases where the repair is performed more than two weeks after the injury, particularly if there is significant contamination of the wound. The surgical approach involves making a dorsal incision to expose the tendon, with careful dissection of surrounding soft tissues to protect vital neurovascular structures. The surgeon locates the distal and proximal ends of the ruptured tendon, which may necessitate an additional incision. In cases where a bone fragment is involved, it may be secured to the distal phalanx using pins or screws. The unique aspect of CPT® Code 26434 is the use of a free graft, which is harvested from either the forearm or leg, and is then sutured to the proximal end of the ruptured tendon, with the distal end secured to the tendon or the distal phalanx, ensuring proper alignment and function post-repair.