CPT® Code 28545

1. Indications

The closed treatment of tarsal bone dislocation, as described by CPT® Code 28545, is indicated for specific conditions and symptoms associated with dislocation of the tarsal bones, excluding the talotarsal joint. The following are the primary indications for this procedure:

• Tarsal Bone Dislocation - This procedure is performed when there is a dislocation of the tarsal bones, which may present with significant pain, swelling, and deformity in the mid-foot region.
• Neurovascular Compromise - Indications include cases where the neurovascular status of the foot is compromised, such as the absence of a pulse, necessitating urgent intervention to restore proper alignment and blood flow.
• Intact Neurovascular Status - If the neurovascular status is intact, the procedure is indicated to correct the dislocation and prevent further complications, ensuring proper function and alignment of the foot.

2. Procedure

The closed treatment of tarsal bone dislocation involves several critical procedural steps, which are outlined as follows:

• Evaluation of Neurovascular Status - The first step in the procedure is to assess the neurovascular status of the foot. This evaluation is crucial to determine if there is adequate blood flow and nerve function, which will guide the urgency and method of treatment.
• Emergent Reduction (if necessary) - In cases where the evaluation reveals an absence of pulse, an emergent reduction of the affected mid-foot joint is performed immediately. This step is critical and is done without obtaining pre-reduction radiographs to quickly restore blood flow and prevent further complications.
• Radiographic Assessment - If the neurovascular status is intact, separate radiographs are obtained to visualize the dislocation and assess the extent of the injury. This imaging is essential for planning the reduction and ensuring proper alignment.
• Application of Longitudinal Traction - With the knee flexed, longitudinal traction is applied to the foot. This technique involves pulling the foot in a straight line to help realign the dislocated bones while simultaneously applying pressure to the involved bones to facilitate the reduction process.
• Post-Reduction Evaluation - After the dislocation is reduced, the neurovascular status is re-evaluated to ensure that blood flow and nerve function have been restored. A second set of radiographs is also obtained to confirm that the bones are properly aligned following the reduction.
• Immobilization and Post-Procedure Care - Once the reduction is confirmed, the foot is immobilized in a splint to maintain the correct position during the healing process. The patient is then instructed to ice the foot and elevate it to reduce swelling and promote recovery.

3. Post-Procedure

After the closed treatment of tarsal bone dislocation, the patient is advised to follow specific post-procedure care instructions. The foot should be kept immobilized in a splint to ensure stability and prevent re-dislocation during the healing phase. Patients are typically instructed to apply ice to the affected area to minimize swelling and discomfort. Elevating the foot is also recommended to further reduce swelling and promote circulation. Follow-up appointments may be necessary to monitor the healing process and to assess the need for further interventions, such as physical therapy or additional imaging studies, to ensure optimal recovery and function of the foot.