CPT® Code 28605

1. Indications

The closed treatment of tarsometatarsal joint dislocation, as described by CPT® Code 28605, is indicated for patients presenting with a Lisfranc dislocation. This condition typically manifests with symptoms such as severe foot pain, swelling, and difficulty bearing weight. The procedure is performed when the dislocation requires intervention under anesthesia, particularly when the neurovascular status of the foot is compromised or when the dislocation is significant enough to necessitate closed reduction for proper alignment and function.

• Severe Foot Pain The patient experiences intense pain in the foot, particularly in the midfoot region, which may indicate a dislocation.
• Swelling Noticeable swelling around the tarsometatarsal joint area, suggesting injury or dislocation.
• Inability to Bear Weight The patient is unable to put weight on the affected foot, indicating a potential dislocation that requires treatment.
• Compromised Neurovascular Status Evaluation shows inadequate blood flow to the foot, necessitating urgent intervention.

2. Procedure

The closed treatment of tarsometatarsal joint dislocation involves several critical procedural steps to ensure proper alignment and recovery. Initially, the patient's neurovascular status is assessed to determine if blood flow to the foot is adequate. If a pulse is absent, this indicates a potential emergency, and immediate reduction of the dislocated joint is performed without obtaining pre-reduction radiographs. This urgent intervention is crucial to restore blood flow and prevent further complications.

• Step 1: Neurovascular Assessment The first step involves evaluating the neurovascular status of the foot. This assessment is vital to ensure that the blood supply is intact before proceeding with any treatment.
• Step 2: Emergent Reduction If the neurovascular assessment reveals an absent pulse, the physician performs an emergent reduction of the joint. This step is critical and is done without pre-reduction radiographs to quickly restore alignment and blood flow.
• Step 3: Radiographic Evaluation If the neurovascular status is intact, the physician obtains separately reportable radiographs to assess the extent of the dislocation and confirm the diagnosis before proceeding with the reduction.
• Step 4: Closed Reduction Technique The closed reduction is then performed by applying longitudinal traction to the foot while exerting pressure on the involved bones. This technique aims to realign the dislocated joint effectively.
• Step 5: Post-Reduction Assessment After the reduction, the neurovascular status is re-evaluated to ensure that blood flow has been restored. A second set of radiographs is obtained to confirm that the joint is properly aligned following the procedure.
• Step 6: Immobilization and Patient Instructions Finally, the toe is immobilized in a splint to maintain the correct position during the healing process. The patient is instructed to ice and elevate the foot to reduce swelling and promote recovery.

3. Post-Procedure

Following the closed treatment of tarsometatarsal joint dislocation, the patient is advised on post-procedure care to facilitate recovery. The immobilization of the toe in a splint is essential to maintain proper alignment and prevent re-dislocation. Patients are instructed to apply ice to the affected area to manage swelling and to elevate the foot to further reduce edema. Regular follow-up appointments may be necessary to monitor the healing process and to obtain additional radiographs as needed to ensure that the joint remains properly aligned. Patients should also be educated on signs of complications, such as increased pain, swelling, or changes in neurovascular status, which would require immediate medical attention.