Distal Radius ORIF (Volar Plate)

CPT 25600
Approach Open
Add-on / Variant CPTs
  • 25607 — Open treatment distal radial fracture, with plate/screw
  • 25609 — Open treatment distal radial fracture, complex
Preoperative Diagnosis:

Right [left] distal radius fracture, [intra-articular / extra-articular] [/ dorsally angulated / comminuted / with ulnar styloid fracture]

Postoperative Diagnosis:

Same

Procedure Performed:

Right [left] distal radius open reduction and internal fixation, volar locking plate

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

Regional [WALANT / Bier block / axillary block] [/ general]

Indications:

The patient is a [age]-year-old [male/female] who sustained a right [left] distal radius fracture after [fall on outstretched hand / high-energy trauma]. Radiographs demonstrate [dorsal angulation / articular comminution / radial shortening / ulnar variance] meeting criteria for surgical fixation. The risks, benefits, and alternatives were discussed and informed consent was obtained.

Findings:

The distal radius fracture was [intra-articular / extra-articular] with [dorsal / volar] comminution. Pre-operative measurements: radial inclination [X°], volar tilt [−X°] (dorsal), radial height [X] mm, ulnar variance [+X] mm. Post-reduction: radial inclination [X°], volar tilt [+X°], radial height [X] mm. The median nerve was [intact pre-operatively / with acute carpal tunnel syndrome requiring release].

Description of Procedure:

The patient was positioned supine with the arm on a hand table. A forearm tourniquet was applied. The volar forearm was prepped and draped.

A [4]-cm volar longitudinal incision was made in the FCR tendon sheath. The FCR tendon was retracted [ulnarly]. The volar radial sheath was incised and the pronator quadratus was elevated off the volar radial border with electrocautery. The fracture was exposed.

Under fluoroscopic guidance, the fracture was reduced with traction and volarly directed pressure. [A K-wire was used for provisional fixation.] Reduction was confirmed on AP and lateral fluoroscopic views: volar tilt [+10°], radial height [X] mm, radial inclination [X°], articular step-off [<2 mm].

A [Variable Angle LCP / Aptus / DVR Anatomic] volar locking plate was positioned on the volar radial surface, [X] mm proximal to the watershed line. The plate was secured with a shaft screw, and position was confirmed fluoroscopically. Locked distal screws were placed under fluoroscopic guidance confirming sub-articular position without intra-articular penetration on AP, lateral, and [45°] oblique views.

The pronator quadratus was repaired over the plate with [2-0 Vicryl] to reduce tendon irritation. The FCR sheath was closed. Skin was closed with [3-0 Monocryl].

Complications:

None

Specimens:

None

Estimated Blood Loss:

Minimal (tourniquet)

Drains:

None

Disposition:

The patient was placed in a volar splint with the wrist in neutral. Finger range of motion was initiated immediately. Weight-bearing on the operative arm was restricted. Follow-up in [2 weeks] for wound check and splint change to removable brace.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Right/Left distal radius fracture, ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: Right/Left distal radius ORIF, volar locking plate
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: ***

INDICATIONS: .PTAGE-year-old .PTSEX with distal radius fracture, ***. Criteria for fixation met. Consent obtained.

FINDINGS: *** fracture. Pre-op: volar tilt ***°, radial height *** mm, inclination ***°. Post-reduction: volar tilt +***°, height *** mm. Median nerve ***.

PROCEDURE:
Supine, hand table. Forearm tourniquet. FCR approach. PQ elevated off volar radius. Fracture exposed. Reduced under fluoro — AP/lateral confirmed. Provisional K-wire. *** volar plate positioned *** mm proximal to watershed line. Shaft screw, position confirmed. Locked distal screws — sub-articular, no intra-articular penetration on AP/lateral/oblique. PQ repaired over plate with 2-0 Vicryl. FCR closed. Skin closed. Volar splint.

EBL: Minimal
COMPLICATIONS: None
DISPOSITION: Volar splint, neutral wrist. Finger ROM immediately. Follow-up 2 weeks.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Concomitant Carpal Tunnel Release

Pre-operatively, the patient had acute carpal tunnel syndrome with [median nerve paresthesias / thenar wasting / positive Phalen]. Carpal tunnel release was performed through extension of the volar incision. The transverse carpal ligament was divided under direct vision from proximal to distal, protecting the recurrent motor branch of the median nerve. The median nerve was decompressed and confirmed with a nerve stimulator. Carpal tunnel release was performed prior to fracture fixation to allow median nerve decompression before tourniquet deflation.

Bridging External Fixation (Highly Comminuted / Open Fracture)

Given highly comminuted intra-articular injury [/ open fracture / severe soft tissue compromise], bridging external fixation was applied as a staged procedure or definitive treatment. [2] pins were placed in the second metacarpal and [2] pins in the radial shaft. The frame was assembled with distraction to restore radial length via ligamentotaxis. [Limited internal fixation of articular fragments was performed percutaneously.] Definitive ORIF will be performed [if soft tissues permit, at 7–10 days].

Charting Tips
  • Document distal screw position relative to the watershed line. Plates placed distal to the watershed line have direct tendon contact with the flexor tendons, causing rupture (most commonly FPL). Document that the plate was positioned proximal to the watershed line and that lateral fluoroscopy confirmed sub-watershed placement.
  • Document the sky-line (tangential) or tilt view confirming no dorsal screw penetration. Locked distal screws that are too long will penetrate the dorsal cortex and cause extensor tendon rupture (EPL most common). Document the confirmatory fluoroscopic view used.
  • Record post-reduction radiographic measurements (volar tilt, radial height, radial inclination, ulnar variance). These parameters define the adequacy of reduction and serve as the baseline for post-operative comparison if malunion is later suspected.
Billing Tips
  • Bill 25607 for distal radius ORIF, extra-articular (9.32 wRVU, 90-day global). Bill 25608 for intra-articular with 2 fragments (10.79 wRVU). Bill 25609 for intra-articular with 3 or more fragments (14.02 wRVU). Fragment count at time of surgery determines the code.
  • Document the number of articular fragments on preoperative CT and intraoperative assessment, as this is the key billing determinant. Volar locking plate technique is used for all three codes; implant type does not change the CPT.
  • Concomitant ulnar styloid fixation is typically bundled unless a formal ulnar styloid ORIF is performed as a distinct procedure. Document whether ulnar styloid was addressed and to what extent.
  • 90-day global period: cast or splint management, occupational therapy referral, and routine X-ray checks are bundled. Hardware removal for symptomatic hardware at a later date is separately billable.
  • Document neurovascular exam pre- and postoperatively, fracture classification (Frykman or AO), and all implants placed (plate brand, size, screw lengths and positions), as these are required for implant registry documentation.