S82.421N Displaced transverse fracture of shaft of right fibula, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

Name of the Condition

• Displaced transverse fracture of shaft of right fibula, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
• ICD-10 Code: S82.421N

Summary

This condition describes a displaced transverse fracture of the right fibula shaft, where the bone fragments are misaligned and the fracture line runs horizontally. The fracture is open (skin is pierced) and classified as type IIIA, IIIB, or IIIC, indicating severe soft tissue damage. It is a subsequent encounter, meaning the patient is receiving care for a nonunion—where the fracture has failed to heal properly after an initial treatment period.

Causes

Most commonly caused by high-impact trauma to the lower leg, such as motor vehicle accidents, falls, or severe sports injuries. Open fractures may result from the bone fragment piercing the skin during the injury. Nonunion can develop due to inadequate initial treatment, poor blood supply, infection, or excessive movement at the fracture site.

Risk Factors

• Severe initial trauma or open fracture with extensive soft tissue damage.
• Poor blood supply to the fracture site, which impairs healing.
• Infection at the fracture site, which delays or prevents union.
• Smoking or other factors that reduce bone healing capacity.
• Noncompliance with immobilization or weight-bearing restrictions.

Symptoms

• Persistent pain, swelling, or tenderness at the fracture site.
• Difficulty bearing weight on the affected leg.
• Visible deformity or instability of the leg structure.
• Open wound at the fracture site (for open fractures).
• Possible signs of infection, such as redness, warmth, or drainage.

Diagnosis

Diagnosis involves a physical examination to assess tenderness, swelling, and deformity. Imaging tests, such as X-rays or CT scans, are used to confirm the fracture, evaluate alignment, and assess for nonunion. Additional tests, like MRI or bone scans, may be performed to evaluate soft tissue damage or healing potential. Clinical history, including prior treatments and time since injury, is also considered.

Treatment Options

Treatment focuses on promoting fracture union and managing soft tissue damage. Options may include surgical intervention, such as internal fixation with plates or screws, bone grafting to stimulate healing, or external fixation. Antibiotics are used for open fractures with infection. Physical therapy is often recommended to restore function and strength once healing progresses.

Prognosis and Follow-Up

Prognosis depends on the severity of the fracture, soft tissue damage, and response to treatment. Nonunion may require additional interventions, and recovery can be prolonged. Regular follow-up with imaging is necessary to monitor healing. Long-term outcomes may include residual pain, limited mobility, or the need for further surgery.

Complications

• Nonunion or delayed healing, requiring additional treatment.
• Infection at the fracture site, especially with open fractures.
• Nerve or blood vessel damage, leading to numbness or circulation issues.
• Chronic pain or arthritis in the affected leg.
• Muscle weakness or reduced range of motion.

Lifestyle & Prevention

• Avoid high-impact activities until cleared by a healthcare provider.
• Follow weight-bearing restrictions and immobilization guidelines.
• Maintain a healthy diet rich in calcium and vitamin D to support bone health.
• Quit smoking, as it impairs bone healing.
• Use protective gear during sports or high-risk activities to reduce injury risk.

When to Seek Professional Help

Seek immediate medical attention if you experience severe pain, swelling, or deformity after an injury. Contact a healthcare provider if you notice signs of infection, such as redness, warmth, or drainage from the wound, or if pain persists despite treatment.

Tips for Medical Coders

This code is used for a subsequent encounter of a displaced transverse fracture of the right fibula shaft with nonunion, where the fracture is open and classified as type IIIA, IIIB, or IIIC. Documentation should specify the fracture type, laterality (right), and the presence of nonunion. Ensure the encounter is coded as subsequent, not initial, and that open fracture details are clearly documented to support the type III classification.