S82.033K Displaced transverse fracture of unspecified patella, subsequent encounter for closed fracture with nonunion

Name of the Condition

• Displaced transverse fracture of unspecified patella, subsequent encounter for closed fracture with nonunion

Summary

This condition describes a horizontal break in the kneecap (patella) where the bone fragments are not aligned, occurring during a subsequent encounter for a closed fracture (no open wound) that has failed to heal (nonunion). The term "unspecified" indicates the side (left or right) is not documented. Nonunion means the fracture has not healed after an expected period, requiring further management.

Causes

Direct trauma to the knee, such as a fall onto the kneecap, a blow from an object, or a forceful contraction of the quadriceps muscle. High-impact injuries, like those from sports or motor vehicle accidents, are common triggers. Nonunion may result from inadequate immobilization, poor blood supply, infection, or excessive movement during healing.

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.
• Smoking or poor nutrition, which can impair bone healing.

Symptoms

• Persistent pain in the knee, often worsening with activity.
• Swelling and bruising around the kneecap that does not resolve.
• Inability to bear weight or straighten the knee fully.
• Visible deformity or a gap in the kneecap area.
• A "popping" sensation at the time of injury (if recent trauma).
• Lack of improvement in symptoms over time, indicating nonunion.

Diagnosis

A physical examination to assess knee movement, swelling, and tenderness. Imaging studies, typically X-rays, to confirm the fracture and evaluate bone alignment. In some cases, a CT scan may be used to assess complex fractures or nonunion. Additional tests, such as blood work, may rule out infection or nutritional deficiencies.

Treatment Options

• Immobilization with a cast or brace to stabilize the knee and promote healing.
• Surgical intervention, such as internal fixation with screws or plates, to realign and stabilize the fracture.
• Bone grafting to stimulate healing in cases of nonunion.
• Physical therapy to restore strength and mobility after healing.
• Pain management with medications or other modalities.

Prognosis and Follow-Up

Prognosis depends on the severity of the fracture, treatment adherence, and overall health. Nonunion may require extended treatment, including surgery. Regular follow-up with imaging is necessary to monitor healing. Most patients can regain function with appropriate care, though some may experience long-term stiffness or weakness.

Complications

• Chronic pain or arthritis in the knee.
• Limited range of motion or stiffness.
• Infection, especially if surgery is required.
• Nerve or blood vessel damage near the knee.
• Delayed or failed healing (nonunion) requiring additional intervention.

Lifestyle & Prevention

• Avoid high-impact activities until cleared by a healthcare provider.
• Use protective gear during sports or activities with knee injury risk.
• Maintain a healthy diet rich in calcium and vitamin D to support bone health.
• Quit smoking, as it impairs bone healing.
• Follow post-treatment instructions carefully to promote recovery.

When to Seek Professional Help

Seek immediate medical attention if you experience severe knee pain, swelling, or inability to bear weight after an injury. Contact a healthcare provider if symptoms persist or worsen, or if you notice signs of infection (e.g., fever, redness, drainage).

Tips for Medical Coders

Document the encounter as a subsequent visit for a closed fracture with nonunion. Ensure the code S82.033K is used when the fracture is displaced, transverse, unspecified, and the encounter is for a closed fracture with nonunion. Verify that the fracture type (closed) and healing status (nonunion) are clearly documented in the medical record.