S49.122K Salter-Harris Type II physeal fracture of lower end of humerus, left arm, subsequent encounter for fracture with nonunion

Name of the Condition

• Salter-Harris Type II physeal fracture of lower end of humerus, left arm, subsequent encounter for fracture with nonunion (ICD-10 Code: S49.122K)

Summary

This code describes a Salter-Harris Type II fracture involving the growth plate (physeal) at the lower end of the left humerus, with nonunion during a subsequent encounter. The fracture includes a separation of the growth plate with a metaphyseal fragment, and nonunion indicates the fracture has not healed properly after prior treatment. These injuries are common in children and adolescents due to the relative weakness of the growth plate compared to surrounding bone.

Causes

Trauma is the primary cause, often resulting from a fall onto an outstretched hand or a direct blow to the elbow. Sports-related injuries or accidents involving forceful arm movement can disrupt the growth plate and adjacent bone. Nonunion may occur if the initial fracture was not properly aligned, immobilized, or if there is inadequate blood supply to the fracture site.

Risk Factors

• Age (most common in children and adolescents with open growth plates)
• Participation in high-impact or contact sports
• Prior growth plate injuries or developmental abnormalities
• Inadequate initial fracture management or immobilization
• Poor blood supply to the fracture site

Symptoms

• Persistent pain and swelling at the elbow or lower arm
• Tenderness over the distal humeral growth plate and metaphysis
• Limited range of motion in the affected arm
• Possible visible deformity or instability
• Difficulty bearing weight or using the arm normally

Diagnosis

Diagnosis involves a physical examination to assess pain, swelling, and range of motion. Imaging studies, such as X-rays or MRI, are used to confirm the fracture type, assess healing, and identify nonunion. The provider evaluates the fracture site for signs of improper healing, such as a persistent gap or lack of bone union. Clinical history, including prior treatment and time since injury, is also considered.

Treatment Options

Treatment may include surgical intervention to realign and stabilize the fracture, such as internal fixation with pins or screws. Non-surgical options, like casting or bracing, may be used if the fracture is stable. Physical therapy is often recommended to restore function and strength. In some cases, bone grafting or other procedures may be necessary to promote healing.

Prognosis and Follow-Up

Prognosis depends on the severity of the nonunion and the effectiveness of treatment. With proper management, many patients achieve functional recovery, though some may experience long-term limitations in range of motion or strength. Regular follow-up appointments are necessary to monitor healing and adjust treatment as needed.

Complications

• Chronic pain or discomfort
• Limited range of motion or stiffness
• Growth disturbances or limb length discrepancy
• Arthritis or joint degeneration over time
• Need for additional surgeries

Lifestyle & Prevention

• Avoid high-impact activities until cleared by a healthcare provider
• Use proper protective equipment during sports
• Follow rehabilitation guidelines to restore strength and mobility
• Maintain a healthy diet to support bone healing
• Attend all follow-up appointments to monitor progress

When to Seek Professional Help

Seek medical attention if there is increasing pain, swelling, or deformity, or if the arm cannot be used normally. Prompt evaluation is important if there are signs of infection, such as redness, warmth, or fever, or if the fracture site feels unstable.

Tips for Medical Coders

This code is used for a subsequent encounter for a Salter-Harris Type II physeal fracture of the left humerus with nonunion. Document the encounter type (subsequent) and the presence of nonunion clearly. Ensure the fracture location (left arm) and type (Salter-Harris II) are specified. Follow guidelines for coding fractures with delayed healing or nonunion, and verify that the encounter is not an initial or acute phase of treatment.