I have an op note that I could use some help on:
Dx. is madelung's deformity wrist
Procedure: 1. Excision anomalous vickers ligment volar wrist
2. Epiphysiolysis of distal radius epiphysis with interpositional of free fat graft

... incision made in the distal forearm centered over the ulnar aspect of the distal radius. The median nerve was identified, there was a large persistent median artery present and the median nerve began to bifurcate in the distal forearm at the edge of the entrance of the carpal canal. The nerve was retracted. The pronator quadratus was identified & was detached from its radial aspect leaving a cuff of tissue for later repair. The pronator quadratus was then mobilized ulnarward & the distal radius well exposed. The thickened Vickers ligament was easily identified. This was dissected off the distal radius & an incision was made in the volar capsule. The capsule was dissected off the bufurcating ligament as the ligament was attached to the lunate, triquetrum & the radial volar aspect of the triangle fibrocartilage complex. The vickers ligament was dissected off the ulnar half of the lunate & off the volar aspect of the triquetrum. A volar portion of the TFCC was also needed to be excised to remove the ligament. The distal radioulnar joint was stable following resection of the ligament & the small portion of the TFCC. With a small 27-gauge needle, the distal radial epiphysis on the ulnar aspect was identified. The epiphysis was elevated @ its proximal base & a free fat graft from the forearm subcutaneous tissues was then placed in the elevated epiphysis to hold into position. This was sutured to the epiphysis with sutures. The capsular tissues were then closed over the volar aspect of the wrist. The lunate & truquetrum was stable. The scaphoid lunate & triquetrum were stable. The pronator quadratus was then repaired with sutures as was the volar capsule.

So I am coming up with 25450 for #2. I am thinking 25337 for #1 procedure.

Any help would be appreciated. Thanks.