S82.152M Displaced fracture of left tibial tuberosity, subsequent encounter for open fracture type I or II with nonunion

Name of the Condition

• Displaced fracture of left tibial tuberosity, subsequent encounter for open fracture type I or II with nonunion

Summary

A displaced fracture of the left tibial tuberosity involves a break in the bony prominence on the anterior upper tibia where the patellar tendon attaches. Displacement means the bone fragments are misaligned. This specific code refers to a subsequent encounter for an open fracture (type I or II) with nonunion, indicating the fracture has not healed properly after previous treatment. Open fractures involve the bone piercing the skin, increasing infection risk, while nonunion means the bone fragments fail to fuse over time.

Causes

Traumatic injury is the primary cause, such as direct impact to the knee, falls, or sudden forceful contraction of the quadriceps muscle. Sports-related incidents, motor vehicle accidents, or other high-impact events can lead to this fracture. Open fractures occur when the broken bone penetrates the skin, and nonunion may result from inadequate immobilization, poor blood supply, or infection.

Risk Factors

• Participation in activities with rapid knee extension or jumping (e.g., basketball, soccer)
• Adolescent growth spurts, especially in athletes
• Previous knee injuries or surgeries
• Osteoporosis or bone-weakening conditions
• High-impact trauma, such as falls or direct blows to the knee
• Inadequate initial fracture management or noncompliance with treatment

Symptoms

• Persistent severe pain and swelling over the tibial tuberosity
• Inability to fully extend the knee or bear weight on the affected limb
• Visible deformity or abnormal positioning of the knee due to bone displacement
• Bruising or discoloration in the affected area
• Possible signs of infection, such as redness, warmth, or drainage (if open fracture present)

Diagnosis

Diagnosis involves a physical examination to assess pain, swelling, and deformity. Imaging studies, such as X-rays, are used to confirm the fracture, evaluate displacement, and assess for nonunion. Additional tests like MRI or CT scans may be ordered to evaluate soft tissue damage or bone healing. Clinical history, including prior treatment and fracture type, is critical for accurate coding.

Treatment Options

Treatment focuses on promoting bone healing and managing infection. Options may include surgical intervention to realign and stabilize the fracture, such as internal fixation with screws or plates. Antibiotics are often prescribed for open fractures to prevent or treat infection. Physical therapy may be recommended to restore knee function and strength once healing progresses.

Prognosis and Follow-Up

Prognosis depends on the severity of the fracture, adherence to treatment, and presence of complications. Nonunion may require additional surgery or bone grafting. Regular follow-up with imaging is necessary to monitor healing. Long-term outcomes may include persistent pain, limited mobility, or arthritis if the fracture does not heal properly.

Complications

• Nonunion or delayed healing of the fracture
• Infection, particularly with open fractures
• Chronic pain or instability in the knee
• Arthritis or joint damage over time
• Nerve or blood vessel injury in severe cases

Lifestyle & Prevention

• Avoid high-impact activities until cleared by a healthcare provider
• Use protective gear during sports or activities with fall risks
• Maintain bone health through proper nutrition (e.g., calcium, vitamin D)
• Follow post-treatment guidelines to support healing
• Engage in gradual, supervised physical therapy to restore function

When to Seek Professional Help

Seek immediate medical attention if you experience severe pain, swelling, or deformity after a knee injury. Contact your healthcare provider if symptoms worsen, or if you notice signs of infection (e.g., redness, drainage, fever) following an open fracture. Follow up regularly to monitor healing and address any concerns about nonunion.

Tips for Medical Coders

This code is used for a subsequent encounter of a displaced left tibial tuberosity fracture that is open (type I or II) with nonunion. Document the fracture type, encounter stage, and nonunion status clearly. Ensure the open fracture classification (type I or II) and nonunion are explicitly noted in the medical record to support accurate coding.