Name of the Condition

• Displaced fracture of proximal phalanx of left lesser toe(s) with nonunion
• Commonly referred to as a "nonunion fracture of the toe"

Summary

This condition involves a break in the bone of the proximal phalanx (near the foot) of the lesser toe(s) on the left foot, where the bone ends fail to heal and fuse back together after initial treatment, known as a nonunion. This is a subsequent encounter, indicating follow-up care for a previously diagnosed fracture.

Causes

• Trauma or injury to the toe, such as stubbing or dropping a heavy object on it.
• Inadequate initial treatment leading to improper healing.
• Biological factors affecting bone healing, such as insufficient blood flow.

Risk Factors

• Advanced age, as older bones tend to have slower healing processes.
• Smoking or tobacco use, which impairs circulation.
• Poor nutritional status, leading to deficiencies in bone-building nutrients.
• Preexisting conditions like osteoporosis or diabetes.

Symptoms

• Persistent pain and swelling in the affected toe.
• Visible deformity or misalignment.
• Inability to bear weight or reduced mobility in the toe.
• Delayed or absent evidence of healing on an X-ray.

Diagnosis

• Physical examination assessing toe alignment and range of motion.
• Imaging tests, primarily X-rays, to visually confirm the lack of healing at the fracture site.
• Sometimes CT or MRI if more detailed imaging is required.

Treatment Options

• Surgical intervention to correct misalignment, often including bone grafts or internal fixation with screws/plates.
• Physical therapy to restore mobility and function post-surgery.
• Use of bone stimulators to promote bone growth and healing.

Prognosis and Follow-Up

• With appropriate treatment, patients often experience a good recovery, but it might require extended rehabilitation.
• Regular follow-ups with imaging tests to monitor bone healing are crucial.
• Possibly extended periods of rest or partial weight-bearing to aid healing.

Complications

• Persistent nonunion and potential chronic pain.
• Risk of further deformity or arthritis in the joint.
• Potential need for more complex surgical interventions.

Lifestyle & Prevention

• Maintain a diet rich in calcium and vitamin D to support bone health.
• Avoid smoking and ensure proper footwear to prevent future injuries.
• Engage in safe physical activities and protect the toes from trauma.

When to Seek Professional Help

• Intensifying pain, swelling, or deformity.
• Signs of infection such as fever, increased redness, or pus.
• Difficulty in moving the toe or worsening joint function.

Additional Resources

• American Academy of Orthopaedic Surgeons (AAOS) website for comprehensive fracture care information.
• Patient support groups, such as those focused on bone health and recovery.

Tips for Medical Coders

• Ensure correct identification of the affected area (left lesser toe(s)) and nonunion status.
• Double-check for any previous coding to confirm it is a subsequent encounter.
• Be attentive to details that specify the displacement and ensure nonunion is accurately reflected in coding.