S82.033N Displaced transverse fracture of unspecified patella, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

Name of the Condition

• Displaced transverse fracture of unspecified patella, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

Summary

This condition describes a horizontal break in the kneecap (patella) where the bone fragments are not aligned. The fracture is classified as open (type IIIA, IIIB, or IIIC), indicating a severe skin wound with extensive soft tissue damage, and is associated with nonunion, meaning the bone has failed to heal properly. This is a subsequent encounter, referring to follow-up care after the initial treatment phase.

Causes

Direct trauma to the knee, such as a high-impact fall, motor vehicle accident, or forceful muscle contraction. Open fractures often result from injuries that penetrate the skin, while nonunion may develop due to inadequate initial stabilization, infection, or poor blood supply to the bone.

Risk Factors

• Severe initial trauma leading to open fracture and tissue damage.
• Inadequate initial treatment or delayed intervention.
• Conditions affecting bone healing, such as diabetes or smoking.
• Infection at the fracture site during the healing process.

Symptoms

• Persistent pain and swelling in the knee, often severe.
• Visible deformity or instability of the kneecap.
• Open wound near the kneecap (may show exposed bone or tissue).
• Inability to bear weight or move the knee normally.
• Signs of nonunion, such as persistent pain months after injury.

Diagnosis

A physical examination to assess knee function, wound healing, and tenderness. Imaging studies, typically X-rays, to confirm nonunion and evaluate bone alignment. CT scans may be used to assess complex fracture patterns or soft tissue damage. Laboratory tests may check for infection if the wound is open.

Treatment Options

• Surgical intervention to realign and stabilize the fracture, often with plates or screws.
• Wound care for open fractures to prevent infection.
• Bone grafting or other procedures to promote healing in cases of nonunion.
• Physical therapy to restore knee function and strength.
• Antibiotics if infection is present.

Prognosis and Follow-Up

Prognosis depends on the severity of the initial injury, success of treatment, and presence of complications. Nonunion may require additional surgeries, and recovery can be prolonged. Regular follow-up with imaging is necessary to monitor healing. Physical therapy is critical to regain mobility, but full function may not be achieved in all cases.

Complications

• Infection at the fracture site or wound.
• Chronic pain or arthritis in the knee.
• Persistent instability or deformity.
• Delayed or failed healing (nonunion).
• Nerve or blood vessel damage from the initial trauma.

Lifestyle & Prevention

• Avoid high-risk activities until cleared by a healthcare provider.
• Use protective gear during sports or activities with knee injury risk.
• Maintain bone health through proper nutrition and exercise.
• Follow post-treatment instructions carefully to support healing.

When to Seek Professional Help

Seek immediate care if there is severe pain, swelling, or an open wound near the kneecap. Contact a provider if pain persists, the knee feels unstable, or there are signs of infection (e.g., redness, pus, fever). Follow up as scheduled for monitoring of nonunion or healing progress.

Tips for Medical Coders

Document the fracture type (IIIA, IIIB, or IIIC) and confirmation of nonunion. Specify if the encounter is for treatment of the nonunion or related complications. Ensure the "subsequent encounter" status is supported by clinical notes indicating follow-up care after the initial phase.