S59.021G Salter-Harris Type II physeal fracture of lower end of ulna, right arm, subsequent encounter for fracture with delayed healing

Name of the Condition

• Salter-Harris Type II physeal fracture of lower end of ulna, right arm, subsequent encounter for fracture with delayed healing

Summary

This condition involves a Salter-Harris Type II fracture of the growth plate (physeal) at the lower end of the right ulna, with delayed healing during a subsequent encounter. The fracture extends through the physis (growth plate) and into the metaphysis. It typically affects children and adolescents, where the growth plate is weaker than surrounding bone. The injury may result from trauma to the forearm, particularly near the wrist joint.

Causes

Salter-Harris Type II physeal fractures often occur due to direct impact, such as a fall onto an outstretched hand, or from forceful twisting of the forearm. These injuries are common in activities involving sudden stops or collisions. Delayed healing may result from inadequate immobilization, poor blood supply, or underlying conditions affecting bone repair.

Risk Factors

• Children and adolescents are at higher risk due to the presence of growth plates.
• Participation in contact sports or activities with a high likelihood of falls increases risk.
• Certain genetic or metabolic conditions affecting bone development may also elevate susceptibility.
• Inadequate initial treatment or non-compliance with immobilization protocols.

Symptoms

• Persistent pain and swelling near the wrist or forearm.
• Difficulty moving the wrist or hand, even with immobilization.
• Tenderness to touch at the fracture site.
• Possible bruising around the affected area.
• Delayed union or non-union noted on imaging.

Diagnosis

Physical examination by a healthcare professional to assess pain, swelling, and range of motion. Imaging tests, especially X-rays, to visualize the fracture and determine its extent. Additional imaging (e.g., MRI) may be used if the fracture is not clearly visible on X-rays. Comparison with prior imaging helps confirm delayed healing.

Treatment Options

• Prolonged immobilization using a cast or splint to support healing.
• Surgical intervention, such as internal fixation, if delayed healing persists.
• Physical therapy to restore range of motion and strength once healing progresses.
• Monitoring with serial imaging to assess fracture union.

Prognosis and Follow-Up

Prognosis depends on the severity of the fracture and adherence to treatment. Most cases heal with appropriate management, but delayed healing may extend recovery time. Follow-up appointments are necessary to monitor healing progress and adjust treatment as needed. Long-term outcomes are generally favorable with proper care.

Complications

• Non-union or malunion of the fracture.
• Growth disturbances due to damage to the growth plate.
• Chronic pain or stiffness in the wrist or forearm.
• Nerve or vascular injury in severe cases.

Lifestyle & Prevention

• Use protective gear during sports or high-risk activities.
• Ensure proper immobilization and follow-up care after initial injury.
• Maintain a healthy diet rich in calcium and vitamin D to support bone healing.
• Avoid activities that stress the injured area until fully healed.

When to Seek Professional Help

Seek medical attention if pain worsens, swelling increases, or mobility does not improve with treatment. Immediate care is needed for signs of infection, severe deformity, or loss of sensation in the hand or fingers.

Tips for Medical Coders

Document the laterality (right arm), fracture type (Salter-Harris Type II), and the presence of delayed healing. Include details of subsequent encounters, such as follow-up visits or imaging findings confirming delayed union. Ensure documentation supports the use of this code for accurate coding and billing.