S42.261A Displaced fracture of lesser tuberosity of right humerus, initial encounter for closed fracture

Name of the Condition

• Displaced fracture of lesser tuberosity of right humerus, initial encounter for closed fracture (ICD Code: S42.261A)

Summary

This condition involves a displaced fracture of the lesser tuberosity, a bony prominence on the right humerus near the shoulder joint. The fracture is closed (skin intact) and is the initial encounter for treatment. The lesser tuberosity serves as an attachment point for the subscapularis muscle, and displacement may affect muscle function or joint stability.

Causes

Displaced fractures of the lesser tuberosity typically result from direct trauma, such as falls onto the shoulder, motor vehicle accidents, or high-impact sports injuries. Low-energy trauma may also cause this type of fracture in individuals with weakened bones.

Risk Factors

• Advanced age and osteoporosis, which reduce bone density.
• Participation in contact sports or activities with a high risk of falls.
• Previous fractures or bone disorders that weaken the skeletal structure.

Symptoms

• Intense pain in the shoulder or upper arm.
• Swelling, bruising, and visible deformity at the fracture site.
• Inability to move the arm or bear weight.
• Numbness or tingling in the hand or fingers if nerve involvement occurs.

Diagnosis

Physical examination to assess pain, range of motion, and deformity. Imaging tests, including X-rays, to visualize the fracture pattern and displacement. CT scans or MRIs may be used for detailed assessment of complex fractures or soft tissue damage.

Treatment Options

• Immobilization with a sling or brace to stabilize the fracture.
• Pain management with medications.
• Surgical intervention to realign and fixate bone fragments if the fracture is significantly displaced or unstable.

Prognosis and Follow-Up

Recovery time varies depending on the severity of the fracture and treatment. Physical therapy may be recommended to restore strength and mobility. Follow-up imaging and clinical evaluations are typically performed to monitor healing progress.

Complications

• Nonunion or malunion of the fracture.
• Nerve or blood vessel damage.
• Chronic pain or reduced shoulder function.
• Post-traumatic arthritis in the shoulder joint.

Lifestyle & Prevention

• Engage in regular weight-bearing exercise to maintain bone density.
• Use protective gear during high-risk activities.
• Ensure adequate calcium and vitamin D intake to support bone health.
• Avoid falls by modifying home environments (e.g., removing tripping hazards).

When to Seek Professional Help

Seek immediate medical attention if you experience severe pain, visible deformity, or inability to move the arm after an injury. Prompt evaluation is important to prevent complications and ensure proper treatment.

Tips for Medical Coders

Document the fracture as displaced, specify the right humerus, and confirm the encounter is initial and the fracture is closed. Include details on the mechanism of injury, clinical findings, and imaging results to support coding accuracy.