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Pediatric Distal Fibula Physeal Fracture S82.409A 823.81

 

synonyms:Pediatric Distal Fibula Physeal Fracture, pediatric ankle fracture, pediatric lateral malleolus fracture

Pediatric Distal Fibula Physeal Fracture ICD-10

 

A- initial encounter for closed fracture

B- initial encounter for open fracture type I or II

C- initial encounter for open fracture type IIIA, IIIB, or IIIC

D- subsequent encounter for closed fracture with routine healing

E- subsequent encounter for open fracture type I or II with routine healing

F- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

G- subsequent encounter for closed fracture with delayed healing

H- subsequent encounter for open fracture type I or II with delayed healing

J- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

K- subsequent encounter for closed fracture with nonunion

M- subsequent encounter for open fracture type I or II with nonunion

N- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

P- subsequent encounter for closed fracture with malunion

Q- subsequent encounter for open fracture type I or II with malunion

R- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

S- sequela

Pediatric Distal Fibula Physeal Fracture ICD-9

  • 823.81 unspecified closed: lower leg NOS, fibular alone

Pediatric Distal Fibula Physeal Fracture Etiology / Epidemiology / Natural History

  • twisting mechanism to the lower leg during sports or recreation.
  • Ankle injuries are very common in children and adolescents and second only to wrist and hand injuries

Pediatric Distal Fibula Physeal Fracture Anatomy

  • Ankle ligaments (deltoid ligament, posterior talofibular ligament, calcaneofibular ligament, and anterior talofibular ligament; posterior tibiofibular ligament and anterior tibiofibular ligament) are generally stronger than the growing physis; thus, osseous injury is more common then ligamentous injury in children and adolescents.
  • Fibula bears 6-16% of body weight

Pediatric Distal Fibula Physeal Fracture Clinical Evaluation

  • Pain and deformity in the ankle, inability to bear weight, ankle swelling, ecchymosis, degree dependent on fracture severity.
  • Evaluate skin integrity, swelling, and neurovascular status of the leg/foot.

Pediatric Distal Fibula Physeal Fracture Xray / Diagnositc Tests

  • A/P, lateral and mortise views of the ankle.
  • CT: consider for intra-articular fractures
  • MRI generally not indicated although can provide information on ligamentous and physeal injury. (Lohman M, Skeletal Tadiol 2001;30:504).

Pediatric Distal Fibula Physeal Fracture Classification / Treatment

  • Salter-Harris type I or II:  typically low-energy trauma. Treatment = short leg walking cast.
  • Salter-Harris type III or IV:  rare. 
  • Accessory ossification center (os fibulare). Normal anatomic variant  at the distal tip of the fibula often misinterpreted as an avulsion fracture.

Pediatric Distal Fibula Physeal Fracture Associated Injuries / Differential Diagnosis

  • Triplane Ankle Fracture
  • Juvenile Tillaux Ankle Fracture
  • Adolescent Pilon Fracture
  • Incisural Ankle Fracture
  • Pediatric distal tibial physeal fracture

Pediatric Distal Fibula Physeal Fracture Complications

  • Delayed union, nonunion
  • Malunion
  • Growth arrest
  • Arthritis
  • Osteonecrosis of the distal tibial epiphysis
  • Compartment syndrome

Pediatric Distal Fibula Physeal Fracture Follow-up Care

  • Follow-up xrays every 6 months for 2 years or until skeletal maturity to assess for physeal damage and deformity.

Pediatric Distal Fibula Physeal Fracture Review References

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