S72.122K Displaced fracture of lesser trochanter of left femur, subsequent encounter for closed fracture with nonunion

Name of the Condition

• Displaced fracture of lesser trochanter of left femur, subsequent encounter for closed fracture with nonunion

Summary

This condition describes a displaced fracture of the lesser trochanter in the left femur where the bone fragments remain out of alignment, and the fracture has failed to heal (nonunion) during a subsequent encounter. The lesser trochanter is a bony prominence on the femur that serves as an attachment point for muscles. Displacement indicates the fracture fragments have shifted from their normal anatomical position, which may affect muscle function and stability. The fracture is closed, meaning the skin is intact, and the nonunion signifies incomplete healing despite prior treatment.

Causes

Displaced fractures of the lesser trochanter typically result from trauma, such as falls or direct impact injuries. Nonunion may occur due to inadequate immobilization, poor blood supply to the fracture site, infection, or excessive movement during healing. They can also happen in individuals with weakened bones due to conditions like osteoporosis, where even minor stress may cause a fracture that fails to heal properly.

Risk Factors

• Advanced age, particularly in postmenopausal women with osteoporosis.
• Conditions that weaken bones, such as osteoporosis, osteopenia, or metastatic bone disease.
• Participation in high-impact or contact sports.
• History of previous fractures or falls.
• Sedentary lifestyle or reduced bone density due to inactivity.
• Smoking or poor nutrition, which can impair bone healing.

Symptoms

• Persistent pain in the hip or groin area, often worsened by movement.
• Swelling and bruising around the hip that may not resolve.
• Difficulty bearing weight on the affected leg.
• Muscle weakness or limited range of motion in the hip.
• Possible clicking or grinding sensations with movement.

Diagnosis

Diagnosis involves a physical examination to assess pain, swelling, and range of motion. Imaging studies, such as X-rays or CT scans, are used to confirm the fracture, assess displacement, and evaluate for nonunion. Additional tests, like bone scans or MRI, may be ordered to assess blood flow and healing potential. The clinician will also review the patient’s history of the initial injury and prior treatments.

Treatment Options

Treatment focuses on promoting healing and restoring function. Options may include surgical intervention, such as internal fixation with screws or plates, to stabilize the fracture. Non-surgical approaches, like prolonged immobilization with a brace or cast, may be considered for select cases. Physical therapy is often recommended to improve strength and mobility once healing progresses. In some instances, bone grafting or electrical stimulation may be used to encourage union.

Prognosis and Follow-Up

Prognosis depends on the severity of the fracture, the patient’s overall health, and adherence to treatment. Nonunion fractures may require extended recovery periods or additional interventions. Regular follow-up appointments with imaging studies are necessary to monitor healing. Most patients can regain functional mobility, but some may experience long-term limitations in activity or chronic pain.

Complications

• Chronic pain or discomfort in the hip or groin.
• Persistent nonunion requiring further surgery.
• Muscle weakness or reduced range of motion.
• Risk of future fractures due to weakened bone.
• Possible need for long-term assistive devices, such as crutches or a cane.

Lifestyle & Prevention

• Maintain a balanced diet rich in calcium and vitamin D to support bone health.
• Engage in weight-bearing exercises to strengthen bones, as recommended by a healthcare provider.
• Use fall prevention strategies, such as removing tripping hazards at home and wearing supportive footwear.
• Avoid high-impact activities that increase fracture risk, especially if bone density is low.
• Quit smoking and limit alcohol, as both can impair bone healing.

When to Seek Professional Help

Seek immediate medical attention if you experience severe hip pain, inability to bear weight, or new swelling after a fall or injury. Contact your healthcare provider if pain persists despite treatment, or if you notice worsening mobility or signs of infection, such as fever or increased redness.

Tips for Medical Coders

Document the subsequent encounter, closed fracture status, and nonunion clearly in the medical record. Ensure the fracture’s displacement and location (left femur, lesser trochanter) are specified, along with any surgical or non-surgical interventions performed. Note the timeline of the encounter relative to the initial injury to confirm the "subsequent" classification.