S82.866J Nondisplaced Maisonneuve's fracture of unspecified leg, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

Name of the Condition

• Nondisplaced Maisonneuve's fracture of unspecified leg, subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

Summary

A Maisonneuve's fracture is a specific type of ankle injury involving a fracture of the proximal fibula (upper portion of the smaller lower leg bone) combined with a tear of the syndesmotic ligaments and often an associated injury to the medial malleolus or deltoid ligament. The term "nondisplaced" indicates that the fractured bone fragments remain in their normal alignment. This injury typically results from rotational forces applied to the ankle, commonly seen in trauma such as falls or sports injuries. The "subsequent encounter" designation refers to follow-up care after the initial treatment phase, while "open fracture type IIIA, IIIB, or IIIC" indicates a fracture where the skin is breached with varying degrees of soft tissue damage, contamination, or vascular injury. "Delayed healing" signifies that the fracture has not progressed as expected during the normal healing timeline.

Causes

The fracture is caused by external rotational forces applied to the ankle, often during activities that involve twisting or turning. Common scenarios include falls, motor vehicle accidents, or sports-related impacts where the foot is planted and the body rotates forcefully. The mechanism typically involves the talus rotating outward, stressing the syndesmotic ligaments and causing the proximal fibula to fracture. Open fractures occur when the force is sufficient to penetrate the skin, often due to high-energy trauma or a sharp bone fragment piercing the tissue. Delayed healing may result from factors such as poor blood supply, infection, inadequate immobilization, or underlying medical conditions affecting bone repair.

Risk Factors

• Participation in activities with high rotational stress on the ankle, such as soccer or basketball.
• Previous ankle injuries or ligamentous instability.
• Improper footwear or uneven terrain increasing fall risk.
• Age-related factors that may affect bone density or ligament integrity.
• Conditions that impair healing, such as diabetes, smoking, or nutritional deficiencies.
• High-energy trauma increasing the likelihood of open fractures.

Symptoms

• Persistent pain at the fracture site despite treatment.
• Swelling or bruising that does not resolve over time.
• Difficulty bearing weight on the affected leg.
• Visible wound or skin breach (for open fractures).
• Signs of infection, such as redness, warmth, or drainage.
• Delayed union or nonunion of the fracture on imaging.

Diagnosis

Diagnosis involves a combination of clinical evaluation and imaging studies. The provider will assess the patient's history of trauma, examine the ankle for tenderness, swelling, or instability, and evaluate the open wound (if present) for type and contamination. Radiographic imaging, including X-rays of the ankle and leg, is used to confirm the fracture and assess alignment. Advanced imaging, such as CT or MRI, may be ordered to evaluate soft tissue damage, associated injuries, or the extent of delayed healing. Laboratory tests, such as blood work, may be performed to check for infection or nutritional deficiencies affecting healing.

Treatment Options

Treatment focuses on stabilizing the fracture, promoting healing, and managing the open wound. For open fractures, wound care is prioritized, including irrigation, debridement, and possible antibiotics to prevent infection. Surgical intervention may be required to realign the fracture, stabilize the syndesmosis, or address soft tissue damage. Immobilization with a cast or brace is typically used to protect the fracture during healing. Weight-bearing restrictions are often imposed initially, with gradual progression as healing allows. Physical therapy may be recommended to restore strength and function once the fracture shows signs of progress. In cases of significant delayed healing, additional interventions such as bone grafting or electrical stimulation may be considered.

Prognosis and Follow-Up

Prognosis depends on the severity of the fracture, the success of treatment, and the patient's overall health. Most nondisplaced fractures heal with proper immobilization and care, but open fractures and delayed healing may require extended treatment and have a higher risk of complications. Follow-up appointments are essential to monitor healing progress through clinical assessment and repeat imaging. Adjustments to treatment, such as changes in immobilization or additional interventions, may be made based on healing status. Full recovery can take several months, with return to normal activities guided by the provider's recommendations.

Complications

• Infection, particularly with open fractures.
• Delayed union or nonunion of the fracture.
• Malunion, where the bone heals in an abnormal position.
• Chronic ankle instability or pain.
• Nerve or vascular damage from the initial injury or surgery.
• Post-traumatic arthritis due to joint damage.
• Compartment syndrome, a rare but serious condition involving increased pressure in the leg.

Lifestyle & Prevention

• Avoid high-risk activities or use proper protective equipment during sports.
• Wear supportive footwear and maintain good balance to reduce fall risk.
• Manage underlying conditions that affect bone health, such as diabetes or osteoporosis.
• Follow post-injury care instructions carefully to promote healing.
• Engage in gradual, supervised physical therapy to restore strength and function.

When to Seek Professional Help

Seek immediate medical attention if you experience:

• Severe pain, swelling, or inability to bear weight.
• An open wound associated with the fracture.
• Signs of infection, such as fever, redness, or drainage.
• Numbness, tingling, or changes in skin color below the injury.
• Worsening symptoms or lack of improvement during follow-up care.

Tips for Medical Coders

Document the encounter type (subsequent), fracture type (IIIA, IIIB, or IIIC), and the presence of delayed healing clearly