CPT® Code 28760

Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint (eg, Jones type procedure)

The procedure described by CPT® Code 28760 refers to an arthrodesis involving the great toe, specifically the interphalangeal joint. Arthrodesis is a surgical procedure that fuses two bones together, in this case, the proximal and distal phalanx of the great toe, to eliminate movement at the joint. This is often indicated in cases where there is severe joint pain or instability, typically due to conditions such as arthritis or injury. The procedure involves a meticulous surgical approach, beginning with an incision made over the lateral aspect of the interphalangeal joint. Surgeons must take care to protect surrounding nerves and blood vessels during this process. Once the joint is accessed, the articular cartilage is excised, which is the smooth tissue that covers the ends of bones in a joint, allowing for smooth movement. The next step involves scaling the articular surfaces of the proximal and distal phalanx using an osteotome, a specialized surgical instrument. This prepares the bone surfaces for fusion by exposing cancellous bone, which is the spongy bone that facilitates healing and integration. A key component of this procedure is the transfer of the extensor hallucis longus tendon to the first metatarsal neck. This tendon is responsible for extending the big toe and its transfer helps to stabilize the joint post-fusion. To ensure stability during the healing process, internal fixation devices such as pins, screws, staples, or a small plate are utilized to hold the bones in place across the joint. Finally, the incision is closed, and a bulky dressing is applied to protect the surgical site and support the healing process. This comprehensive approach aims to alleviate pain and restore function to the great toe, enhancing the patient's overall mobility and quality of life.