S72.062N Displaced articular fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

Name of the Condition

• Displaced articular fracture of head of left femur, subsequent encounter for open fracture type IIIA, IIIB, or IIIC 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 IIIA, IIIB, or IIIC), meaning there is a wound communicating with the fracture site, and it is documented as a subsequent encounter, indicating follow-up care for an established injury. The presence of nonunion indicates the fracture has failed to heal properly. Prompt evaluation is necessary to assess the extent of displacement, wound severity, 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 initial treatment, 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
• Inadequate initial fracture management

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 infection (e.g., redness, warmth, fever)

Diagnosis

Physical examination to assess pain, mobility, and limb alignment. Imaging studies, including X-rays or CT scans, to visualize the fracture, displacement, and nonunion. Assessment of the open wound for type (IIIA, IIIB, or IIIC) and signs of infection. Evaluation of healing progress and potential complications.

Treatment Options

• Surgical intervention to realign and stabilize the fracture, often with internal fixation or arthroplasty.
• Wound care and management of the open fracture, including debridement and infection control.
• Bone grafting or other procedures to promote union in cases of nonunion.
• Physical therapy to restore mobility and strength.
• Pain management and supportive care.

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 care is essential to monitor healing, address complications, and guide rehabilitation. Long-term outcomes may include reduced mobility or the need for joint replacement.

Complications

• Infection at the fracture site or wound
• Avascular necrosis (loss of blood supply to the femoral head)
• Chronic pain or arthritis
• Persistent nonunion or malunion
• Limited mobility or disability
• Need for additional surgeries

Lifestyle & Prevention

• Maintain bone health through adequate calcium and vitamin D intake.
• Engage in weight-bearing exercise to strengthen bones.
• Use protective measures during high-risk activities.
• Address fall risks, especially in older adults.
• Follow post-treatment instructions to support healing.

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, redness, drainage). Follow up with a healthcare provider if symptoms worsen or do not improve with treatment.

Tips for Medical Coders

Document the fracture type (IIIA, IIIB, or IIIC) and the presence of nonunion to accurately reflect the condition. Ensure the encounter is coded as subsequent to indicate follow-up care. Include details about the open wound and any complications to support coding accuracy.