S72.113M Displaced fracture of greater trochanter of unspecified femur, subsequent encounter for open fracture type I or II with nonunion

Name of the Condition

• Displaced fracture of greater trochanter of unspecified femur, subsequent encounter for open fracture type I or II with nonunion

Summary

A displaced fracture of the greater trochanter of the femur is a break in the bony prominence on the upper part of the thigh bone (femur) near the hip joint, where the bone fragment has moved out of its normal position. This type of fracture is classified as a subsequent encounter for an open fracture (type I or II) with nonunion, indicating it is a follow-up visit for a fracture that previously involved a skin compromise (limited wound) and has failed to heal properly. The term "unspecified femur" means the side (right or left) is not documented.

Causes

Displaced fractures of the greater trochanter commonly result from direct trauma, such as falls or high-impact injuries. They can also occur in individuals with weakened bones due to conditions like osteoporosis, where even minor stress may cause a fracture with displacement. Open fractures (type I or II) may result from the same mechanisms, with the added factor of skin penetration by the fractured bone or associated trauma. Nonunion may develop due to inadequate stabilization, poor blood supply, infection, or excessive movement at the fracture site.

Risk Factors

• Advanced age, particularly in postmenopausal women with osteoporosis.
• Conditions that weaken bones, such as osteoporosis, cancer, or metabolic disorders.
• History of previous fractures or falls.
• Sedentary lifestyle or limited mobility.
• High-impact activities or trauma.
• Poor fracture healing due to inadequate treatment or comorbidities.

Symptoms

• Persistent hip or groin pain, often worsened by movement.
• Inability to bear weight on the affected leg.
• Swelling, bruising, or deformity around the hip.
• Leg shortening or external rotation.
• Possible signs of nonunion, such as persistent pain or instability despite prior treatment.
• Open wound (if present) with limited skin compromise (type I or II).

Diagnosis

Physical examination to assess pain, range of motion, and deformity. Imaging studies, including X-rays or CT scans, to confirm the fracture, assess displacement, and evaluate for nonunion. Evaluation of the open wound (if present) to determine type (I or II) and check for infection. Review of prior treatment and healing progress to confirm nonunion status.

Treatment Options

• Surgical intervention, such as internal fixation (plates, screws) or bone grafting, to promote healing and stabilize the fracture.
• Antibiotics or wound care for open fractures to prevent infection.
• Pain management with medications or physical therapy to improve mobility.
• Follow-up imaging to monitor healing and adjust treatment as needed.

Prognosis and Follow-Up

Prognosis depends on the severity of the fracture, the success of treatment, and the presence of complications like infection or nonunion. Follow-up care is essential to monitor healing, address nonunion, and restore function. Regular imaging and clinical assessments help track progress and guide rehabilitation.

Complications

• Nonunion or delayed healing.
• Infection, particularly with open fractures.
• Arthritis or joint damage due to improper healing.
• Chronic pain or instability.
• Nerve or blood vessel injury.
• Reduced mobility or functional impairment.

Lifestyle & Prevention

• Maintain bone health with calcium and vitamin D, and engage in weight-bearing exercise.
• Prevent falls by removing hazards, using assistive devices, and improving balance.
• Avoid high-impact activities that increase fracture risk.
• Follow post-treatment instructions to support healing and reduce complications.

When to Seek Professional Help

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

Tips for Medical Coders

Document the fracture type (open, type I or II), the encounter type (subsequent), and the presence of nonunion clearly. Ensure the femur side is documented if known, as "unspecified" is used when not reported. Verify that the open fracture classification aligns with clinical findings and that nonunion is confirmed through imaging or clinical assessment.