S92.321B Displaced fracture of second metatarsal bone, right foot, initial encounter for open fracture

Name of the Condition

• Technical Term: Displaced fracture of second metatarsal bone, right foot, initial encounter for open fracture
• ICD-10 Code: S92.321B
• Common Name: Broken second metatarsal (right foot, open fracture)

Summary

A displaced fracture of the second metatarsal bone in the right foot is a break in the long bone of the midfoot where the bone fragments are misaligned. This is an open fracture, meaning the skin is broken, exposing the bone or underlying tissues. The injury typically results from trauma, such as a direct impact or high-force injury, and requires prompt medical attention due to the risk of infection and further complications. The second metatarsal is a weight-bearing bone, making it susceptible to injury during activities that stress the foot.

Causes

Direct trauma to the right foot, such as a crush injury, fall, or motor vehicle accident, is the most common cause. Open fractures may occur when the force is severe enough to break the skin and underlying tissues. Sports injuries, workplace accidents, or sudden twisting of the foot can also lead to this type of fracture.

Risk Factors

• Participation in high-impact sports or activities (e.g., running, jumping)
• Wearing improper or non-supportive footwear
• Conditions that weaken bones, such as osteoporosis
• Advanced age, which may reduce bone density and balance
• Previous foot injuries or fractures

Symptoms

• Severe pain and tenderness in the midfoot, specifically over the second metatarsal
• Swelling, bruising, and visible bone or tissue exposure (open fracture)
• Difficulty bearing weight or walking on the injured foot
• Possible deformity or misalignment of the foot
• Bleeding or drainage from the open wound

Diagnosis

A healthcare provider will perform a physical examination to assess pain, swelling, and range of motion. Imaging tests, such as X-rays, are typically used to confirm the fracture, assess displacement, and rule out other injuries. The open wound will be evaluated for contamination or infection. Additional tests, like CT scans, may be ordered if detailed imaging of the fracture is needed.

Treatment Options

Treatment focuses on cleaning the wound to prevent infection, realigning the bone fragments (reduction), and stabilizing the fracture. This may involve surgery to fix the bone with pins, screws, or plates, followed by immobilization with a cast or splint. Antibiotics are often prescribed to treat or prevent infection. Pain management and physical therapy may be recommended during recovery.

Prognosis and Follow-Up

Recovery depends on the severity of the fracture and the success of treatment. Most patients heal within 6–8 weeks with proper care, but open fractures carry a higher risk of complications. Follow-up appointments are necessary to monitor healing, remove hardware if used, and assess for infection or delayed union. Physical therapy may be needed to restore strength and mobility.

Complications

• Infection of the open wound or bone (osteomyelitis)
• Delayed healing or nonunion of the fracture
• Nerve or blood vessel damage
• Chronic pain or arthritis in the foot
• Difficulty walking or bearing weight long-term

Lifestyle & Prevention

• Wear supportive, properly fitting footwear during activities.
• Use protective gear (e.g., shin guards) in high-risk sports.
• Maintain bone health with a balanced diet rich in calcium and vitamin D.
• Avoid activities that increase fall or injury risk, especially on uneven surfaces.
• Seek prompt treatment for foot injuries to prevent complications.

When to Seek Professional Help

• Severe pain, swelling, or deformity in the foot.
• Visible bone or tissue exposure (open fracture).
• Inability to bear weight or walk.
• Signs of infection, such as fever, redness, or pus from the wound.
• Numbness, tingling, or coldness in the foot, indicating possible nerve or blood vessel damage.

Tips for Medical Coders

Document the specific metatarsal (second), laterality (right foot), displacement, and open fracture status to assign S92.321B accurately. Ensure the encounter is coded as "initial" for the open fracture. Include details about wound contamination, treatment (e.g., irrigation, debridement), and any associated injuries to support coding and billing.