S72.043K Displaced fracture of base of neck of unspecified femur, subsequent encounter for closed fracture with nonunion

Name of the Condition

• Displaced fracture of base of neck of unspecified femur, subsequent encounter for closed fracture with nonunion (S72.043K)

Summary

This condition involves a break in the upper portion of the femur (thigh bone) at the base of the femoral neck, near the hip joint. The term "displaced" indicates that the bone fragments have shifted out of their normal anatomical position. The "subsequent encounter for closed fracture with nonunion" specifies that this is a follow-up visit for a fracture where the skin remains intact, and the fracture has failed to heal properly (nonunion) after an initial period of treatment.

Causes

High-impact trauma, such as falls or motor vehicle accidents, is a common cause. In older adults, particularly those with weakened bone density (e.g., osteoporosis), fractures may occur from minor trauma or low-impact events. Direct force to the hip or thigh region can also result in this injury. Nonunion may develop due to inadequate immobilization, poor blood supply to the fracture site, infection, or other factors that impede healing.

Risk Factors

• Advanced age, especially in individuals over 65
• Osteoporosis or other bone-weakening conditions
• Female gender, due to higher osteoporosis prevalence
• History of prior fractures or bone diseases
• Participation in high-risk activities (e.g., contact sports)
• Smoking or poor nutrition, which can impair bone healing

Symptoms

• Persistent pain in the hip or groin area, often worsening with movement
• Swelling, bruising, or tenderness around the hip that does not resolve
• Inability to bear weight on the affected leg
• Visible deformity or shortening of the leg
• Limited range of motion in the hip joint
• Possible clicking or grinding sensations during movement

Diagnosis

Physical examination is used to assess pain, swelling, and range of motion. Imaging studies, such as X-rays, CT scans, or MRI, are typically performed to confirm the fracture, evaluate displacement, and assess for nonunion (e.g., visible gap between bone fragments or lack of healing progress over time). Additional tests may be ordered to rule out infection or other complications.

Treatment Options

Treatment depends on the severity of the nonunion and patient factors. Options may include surgical intervention (e.g., internal fixation with plates, screws, or rods; bone grafting to stimulate healing) or non-surgical approaches (e.g., prolonged immobilization, electrical stimulation, or bone growth factors). Physical therapy is often recommended to restore function and strength after healing.

Prognosis and Follow-Up

Prognosis varies based on the extent of the nonunion, patient age, and overall health. Successful treatment can restore hip function, but recovery may be prolonged. Regular follow-up appointments are necessary to monitor healing progress, adjust treatment plans, and address any complications. Long-term outcomes depend on adherence to rehabilitation and addressing underlying risk factors (e.g., osteoporosis).

Complications

• Chronic pain or disability
• Avascular necrosis (loss of blood supply to the femoral head)
• Post-traumatic arthritis of the hip joint
• Infection (if surgical intervention is required)
• Deep vein thrombosis (DVT) or pulmonary embolism due to immobility
• Need for additional surgeries if initial treatment fails

Lifestyle & Prevention

• Maintain a diet rich in calcium and vitamin D to support bone health
• Engage in weight-bearing exercises to strengthen bones (e.g., walking, stair climbing)
• Avoid smoking and limit alcohol, which can impair bone healing
• Use assistive devices (e.g., canes, walkers) to reduce fall risk, especially in older adults
• Wear appropriate footwear and modify home environments to prevent falls

When to Seek Professional Help

Seek immediate medical attention if you experience severe hip pain, inability to bear weight, or visible deformity after an injury. For follow-up care, consult a healthcare provider if pain persists, swelling worsens, or you notice new symptoms (e.g., fever, increased bruising) after a fracture.

Tips for Medical Coders

Document the encounter as a subsequent visit for a closed fracture with nonunion. Ensure clinical notes specify the fracture type (displaced), location (base of neck of unspecified femur), and the presence of nonunion. Include details on treatment provided (e.g., surgical intervention, imaging results) to support code assignment. Verify that the encounter is not an initial visit or for an open fracture, as these would require different codes.