S72.062M Displaced articular fracture of head of left femur, subsequent encounter for open fracture type I or II with nonunion

Name of the Condition

• Displaced articular fracture of head of left femur, subsequent encounter for open fracture type I or II with nonunion

Summary

A displaced articular fracture of the head of the left femur involves a break in the femoral head (the rounded upper portion of the thigh bone that forms part of the hip joint) with the fracture fragments shifted out of their normal alignment. This injury disrupts the joint surface, which is critical for smooth movement. The fracture is classified as open (type I or II), meaning there is a wound communicating with the fracture site, and it is documented as a subsequent encounter, indicating ongoing care for this specific injury. The presence of nonunion indicates the fracture has failed to heal properly. Prompt evaluation is necessary to assess the extent of displacement, wound status, and guide appropriate management.

Causes

High-impact trauma, such as falls or motor vehicle accidents. Low-impact trauma in individuals with weakened bones (e.g., osteoporosis). Direct force to the hip region resulting in an open wound. Factors contributing to nonunion may include inadequate immobilization, poor blood supply, or infection.

Risk Factors

• Advanced age, particularly in those over 65
• Osteoporosis or other bone density disorders
• Female gender, due to higher osteoporosis prevalence
• History of prior fractures or bone diseases
• Participation in high-risk activities (e.g., contact sports)
• Conditions that impair wound healing or increase fracture risk
• Smoking or poor nutrition affecting bone healing

Symptoms

• Persistent hip or groin pain
• Inability to bear weight on the affected leg
• Swelling, bruising, or tenderness around the hip
• Leg shortening or external rotation of the affected limb
• Limited range of motion in the hip joint
• Visible wound or drainage at the fracture site
• Signs of nonunion, such as persistent pain or instability

Diagnosis

Physical examination to assess pain, mobility, limb alignment, and wound status. Imaging studies, including X-rays or CT scans, to visualize the fracture, displacement, and nonunion. Assessment of wound type (I or II) and healing progress. Laboratory tests may be used to evaluate infection or nutritional deficiencies.

Treatment Options

• Surgical intervention to realign and stabilize the fracture, often with internal fixation or arthroplasty.
• Wound care for open fractures, including debridement and infection management.
• Bone grafting or other techniques to promote healing in cases of nonunion.
• Physical therapy to restore mobility and strength.
• Pain management and anti-inflammatory medications.
• Nutritional support to optimize bone healing.

Prognosis and Follow-Up

Prognosis depends on the severity of the fracture, wound type, and success of treatment. Nonunion may require additional interventions. Follow-up imaging and clinical assessments are necessary to monitor healing and joint function. Long-term outcomes may include reduced mobility or arthritis risk.

Complications

• Nonunion or delayed healing
• Infection at the fracture or wound site
• Avascular necrosis of the femoral head
• Post-traumatic arthritis
• Chronic pain or instability
• Nerve or vascular damage
• Wound complications, such as dehiscence

Lifestyle & Prevention

• Fall prevention strategies, such as home modifications and balance training.
• Bone health optimization through diet (calcium, vitamin D) and exercise.
• Avoidance of high-risk activities that increase fracture risk.
• Smoking cessation and management of chronic conditions (e.g., diabetes) that impair healing.
• Prompt treatment of open wounds to reduce infection risk.

When to Seek Professional Help

Seek immediate medical attention for severe hip pain, inability to bear weight, visible wounds, or signs of infection (e.g., fever, drainage). Follow up with a healthcare provider if pain persists, mobility worsens, or nonunion is suspected.

Tips for Medical Coders

Document the fracture type (open I or II), laterality (left femur), and encounter type (subsequent) clearly. Specify nonunion as a key characteristic. Ensure wound details and healing status are recorded to support code assignment.