S82.153N Displaced fracture of unspecified tibial tuberosity, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

Name of the Condition

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

Summary

A displaced fracture of the tibial tuberosity involves a break in the bony prominence on the anterior tibia where the patellar tendon attaches, with misalignment of bone fragments. This code specifies a subsequent encounter for an open fracture (types IIIA, IIIB, or IIIC) that has failed to heal (nonunion). Open fractures involve exposure of the bone through a wound, and nonunion indicates the fracture has not united after an expected healing period.

Causes

Traumatic injury is the primary cause, such as direct impact to the knee, falls, or sudden forceful contraction of the quadriceps muscle. High-impact events like motor vehicle accidents or sports-related incidents can lead to this fracture. Open fractures may result from injuries where the bone pierces the skin, and nonunion can occur due to inadequate initial treatment, infection, or poor blood supply.

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
• Delayed or inadequate initial fracture management

Symptoms

• Severe pain and swelling over the tibial tuberosity
• Inability to fully extend the knee or bear weight
• Visible deformity or abnormal positioning of the knee
• Open wound with exposed bone (for open fractures)
• Persistent pain or instability indicating nonunion

Diagnosis

Diagnosis involves a physical examination to assess pain, swelling, deformity, and wound status. Imaging studies, such as X-rays, are used to confirm the fracture, evaluate displacement, and assess for nonunion. CT scans may be ordered to better visualize bone healing, and MRI can assess soft tissue involvement. Evaluation of the wound and neurovascular status is critical for open fractures.

Treatment Options

Treatment focuses on addressing the nonunion and open fracture. Surgical intervention may include debridement of the wound, internal or external fixation to stabilize the fracture, and bone grafting to promote healing. Antibiotics are used to manage or prevent infection. Physical therapy is essential for restoring function once the fracture is stabilized.

Prognosis and Follow-Up

Prognosis depends on the severity of the fracture, infection risk, and response to treatment. Nonunion may require additional surgeries, and recovery can be prolonged. Regular follow-up with imaging is necessary to monitor healing. Physical therapy is crucial to regain knee strength and mobility, and complications like arthritis or chronic pain may occur.

Complications

• Infection (especially with open fractures)
• Delayed or failed healing (nonunion)
• Chronic pain or instability
• Arthritis in the knee joint
• Nerve or vascular damage
• Limited range of motion

Lifestyle & Prevention

• Avoid high-impact activities until cleared by a healthcare provider
• Use protective gear during sports or high-risk activities
• Maintain bone health through proper nutrition (e.g., calcium, vitamin D)
• Follow post-treatment rehabilitation plans to optimize healing
• Seek prompt treatment for knee injuries to reduce complication risk

When to Seek Professional Help

Seek immediate medical attention for severe knee pain, inability to bear weight, visible deformity, or open wounds. Contact a healthcare provider if pain persists, swelling worsens, or there are signs of infection (e.g., redness, pus, fever). Follow up regularly as recommended to monitor healing.

Tips for Medical Coders

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