S82.026K Nondisplaced longitudinal fracture of unspecified patella, subsequent encounter for closed fracture with nonunion

Name of the Condition

• Nondisplaced longitudinal fracture of unspecified patella, subsequent encounter for closed fracture with nonunion

Summary

A nondisplaced longitudinal fracture of the unspecified patella is a vertical break in the kneecap that does not shift out of alignment. This type of fracture involves the bone remaining in its normal position, which may limit knee movement but typically preserves structural integrity. The injury is classified as closed, meaning the skin is intact, and it is documented during a subsequent encounter for treatment, indicating follow-up care for a fracture that has not healed (nonunion).

Causes

Direct trauma to the knee, such as a fall onto the kneecap, a forceful blow, or a sudden contraction of the quadriceps muscle. High-impact events, like sports injuries or motor vehicle accidents, are common triggers. The nonunion aspect suggests the fracture failed to heal properly during prior treatment.

Risk Factors

• Participation in activities with a high risk of knee injury, such as contact sports or skiing.
• Osteoporosis or other bone-weakening conditions.
• Previous knee injuries or surgeries.
• Advanced age, which may reduce bone density.
• Poor blood supply to the kneecap, which can impede healing.

Symptoms

• Persistent or recurrent pain in the knee, especially with movement.
• Swelling and bruising around the kneecap that does not resolve.
• Inability to fully straighten the knee or bear weight.
• Visible deformity or a gap in the kneecap area (if severe).
• A "popping" sensation at the time of injury (may persist if unstable).

Diagnosis

A physical examination to assess knee movement, swelling, and tenderness. Imaging studies, typically X-rays, to confirm the fracture and evaluate bone alignment. Additional tests, such as CT scans or MRIs, may be used to assess healing status and identify nonunion. Review of prior treatment history to determine if the fracture has failed to heal.

Treatment Options

• Immobilization with a cast or brace to stabilize the knee and promote healing.
• Physical therapy to restore strength and range of motion.
• Surgical intervention, such as internal fixation or bone grafting, if nonunion persists.
• Pain management with medications or other modalities.
• Monitoring for complications, including infection or further injury.

Prognosis and Follow-Up

Prognosis depends on the severity of the nonunion and response to treatment. Most patients can regain functional knee movement with appropriate care, but recovery may be prolonged. Follow-up appointments are necessary to monitor healing and adjust treatment plans. Long-term outcomes may include residual stiffness or weakness.

Complications

• Chronic pain or instability in the knee.
• Limited range of motion or difficulty bearing weight.
• Infection, especially if surgical intervention is required.
• Delayed or failed healing, requiring additional treatment.
• Arthritis in the knee joint over time.

Lifestyle & Prevention

• Avoid high-impact activities until cleared by a healthcare provider.
• Use protective gear during sports or activities with knee injury risk.
• Maintain bone health through diet and exercise to support healing.
• Follow rehabilitation plans to optimize recovery and prevent re-injury.
• Quit smoking, as it can impair bone healing.

When to Seek Professional Help

• Persistent or worsening pain, swelling, or bruising.
• Inability to bear weight or straighten the knee.
• Signs of infection, such as fever, redness, or drainage.
• New or worsening deformity in the knee area.
• Lack of improvement after initial treatment or follow-up care.

Tips for Medical Coders

Document the encounter as a subsequent visit for a closed fracture with nonunion. Ensure the record specifies the fracture type (nondisplaced longitudinal) and the patella as unspecified. Include details about prior treatment and the reason for nonunion, such as inadequate immobilization or poor blood supply, to support coding accuracy. Verify that the encounter is not an initial treatment or for an open fracture.