Name of the Condition

• Nondisplaced Fracture of Proximal Third of Navicular [Scaphoid] Bone of Right Wrist, Subsequent Encounter for Fracture with Nonunion
• Commonly referred to as a nondisplaced scaphoid fracture with nonunion.

Summary

A nondisplaced fracture of the proximal third of the scaphoid bone is a type of wrist fracture where the bone is cracked but remains aligned. A subsequent encounter with nonunion indicates that the fracture has not healed as expected, necessitating further medical intervention.

Causes

• Typically caused by a fall onto an outstretched hand, which applies significant force to the scaphoid bone.
• Other trauma-related incidents to the wrist.

Risk Factors

• Young adults, particularly active individuals and athletes.
• Undertaking activities with a high risk of falls (e.g., skateboarding, snowboarding).
• Poor initial management of the fracture.
• Smoking, which can impede bone healing.

Symptoms

• Pain and tenderness in the wrist, particularly on the thumb side.
• Swelling around the wrist.
• Decreased range of motion.
• Persistent pain long after the initial injury indicates nonunion.

Diagnosis

• Physical examination to check for tenderness over the scaphoid.
• Imaging tests, including X-rays, MRI, or CT scans, to assess the fracture and detect nonunion.

Treatment Options

• Immobilization with a cast or splint, although this might be less effective if nonunion has occurred.
• Surgical intervention, such as bone grafting or internal fixation to ensure proper healing.
• Physical therapy post-surgery to restore wrist function.

Prognosis and Follow-Up

• With appropriate intervention, the prognosis is generally good, but recovery can be prolonged.
• Regular follow-up visits are crucial to monitor healing progress and adjust treatment plans as needed.

Complications

• Persistent pain and stiffness in the wrist.
• Development of arthritis if the fracture and nonunion are not properly managed.
• Potential for further fracture or injury if left untreated.

Lifestyle & Prevention

• Avoid activities that put stress on the wrist during recovery.
• Maintain bone health through a diet rich in calcium and vitamin D.
• Implement fall prevention strategies like wearing protective gear during sports.

When to Seek Professional Help

• Wrist pain persists or worsens after an initial injury.
• Noticeable swelling or change in wrist function.
• Concerns about the healing process post-initial treatment.

Additional Resources

• American Academy of Orthopaedic Surgeons (AAOS)
• National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Tips for Medical Coders

• Verify details such as location (right vs. left wrist) and nature of fracture (nondisplaced with nonunion).
• Ensure the correct subsequent encounter code is used for ongoing treatment.
• Be aware of common errors such as misrepresenting the laterality or fracture type.