ICD-10: S79.14

Salter-Harris Type IV fractures are significant injuries that involve the growth plate (physeal) and metaphysis of long bones, particularly in children and adolescents. The ICD-10 code S79.14 specifically refers to a Salter-Harris Type IV fracture of the lower end of the femur. This type of fracture can have implications for growth and development, making appropriate treatment crucial.

Overview of Salter-Harris Type IV Fractures

Salter-Harris fractures are classified into five types based on the involvement of the growth plate and metaphysis. Type IV fractures extend through the epiphysis, growth plate, and metaphysis, which can potentially disrupt normal growth if not treated properly. The lower end of the femur is a critical area, as it plays a vital role in knee function and overall leg stability.

Standard Treatment Approaches

1. Initial Assessment and Diagnosis

• Clinical Evaluation: A thorough physical examination is essential to assess the extent of the injury, including range of motion and signs of neurovascular compromise.
• Imaging: X-rays are the primary imaging modality used to confirm the diagnosis. In some cases, MRI may be utilized to evaluate soft tissue and growth plate involvement more comprehensively.

2. Non-Surgical Management

• Indications: Non-surgical treatment may be considered if the fracture is non-displaced or minimally displaced.
• Immobilization: The affected limb is typically immobilized using a cast or splint to prevent movement and allow for healing. The duration of immobilization can vary but generally lasts several weeks.
• Follow-Up: Regular follow-up appointments are necessary to monitor healing through repeat imaging and clinical assessments.

3. Surgical Management

• Indications: Surgical intervention is often required for displaced fractures or when there is a risk of growth plate damage.
• Surgical Techniques:
  • Open Reduction and Internal Fixation (ORIF): This is the most common surgical approach, where the fracture is realigned (reduced) and stabilized using plates, screws, or pins.
  • External Fixation: In some cases, especially with complex fractures or soft tissue injuries, external fixation may be employed to stabilize the fracture.
• Postoperative Care: After surgery, the limb may be immobilized again, and rehabilitation will be initiated to restore function.

4. Rehabilitation

• Physical Therapy: Once healing has progressed, physical therapy is crucial to regain strength, flexibility, and range of motion. This may include exercises tailored to the individual’s needs.
• Monitoring Growth: Given the potential impact on growth, ongoing monitoring of the affected limb's growth compared to the contralateral limb is essential.

5. Complications and Long-Term Management

• Potential Complications: Complications can include malunion, nonunion, or growth disturbances, which may necessitate further intervention.
• Long-Term Follow-Up: Regular follow-up visits are important to assess the long-term outcomes of the fracture, including any potential impact on growth and function.

Conclusion

The management of a Salter-Harris Type IV fracture of the lower end of the femur requires a careful and tailored approach, considering the age of the patient, the nature of the fracture, and the potential for growth disturbances. Both non-surgical and surgical options are available, with the choice depending on the specific circumstances of the injury. Ongoing rehabilitation and monitoring are essential to ensure optimal recovery and function.

The ICD-10-CM code S79.14 specifically refers to a Salter-Harris Type IV physeal fracture of the lower end of the femur. Understanding this classification requires a detailed look at both the Salter-Harris classification system and the clinical implications of such fractures.

Salter-Harris Classification Overview

The Salter-Harris classification is a system used to categorize fractures that involve the growth plate (physeal fractures) in children and adolescents. This classification is crucial because it helps predict the potential for growth disturbances and complications. The types are as follows:

• Type I: Fracture through the growth plate, sparing the metaphysis and epiphysis.
• Type II: Fracture through the growth plate and metaphysis, sparing the epiphysis.
• Type III: Fracture through the growth plate and epiphysis, sparing the metaphysis.
• Type IV: Fracture that crosses through the growth plate, metaphysis, and epiphysis, affecting all three components.
• Type V: Compression fracture of the growth plate.

Clinical Description of S79.14

A Salter-Harris Type IV fracture of the lower end of the femur involves a fracture that extends through the epiphysis, across the growth plate, and into the metaphysis. This type of fracture is significant because it can disrupt the normal growth of the femur, potentially leading to complications such as limb length discrepancies or angular deformities if not properly managed.

Symptoms and Diagnosis

Patients with a Salter-Harris Type IV fracture typically present with:

• Pain and Swelling: Localized pain around the knee or thigh, often accompanied by swelling.
• Decreased Range of Motion: Limited ability to move the knee joint due to pain and mechanical instability.
• Deformity: In some cases, there may be visible deformity or abnormal positioning of the leg.

Diagnosis is primarily made through physical examination and imaging studies, such as X-rays, which can reveal the fracture line and its involvement with the growth plate.

Treatment Considerations

Management of a Salter-Harris Type IV fracture often involves:

• Reduction: If the fracture is displaced, closed or open reduction may be necessary to realign the bone fragments.
• Stabilization: Internal fixation (e.g., with plates or screws) is commonly used to stabilize the fracture and allow for proper healing.
• Rehabilitation: Post-surgical rehabilitation is crucial to restore function and strength, often involving physical therapy.

Prognosis

The prognosis for Salter-Harris Type IV fractures can vary based on the severity of the fracture, the age of the patient, and the timing of treatment. Early and appropriate intervention is essential to minimize the risk of complications, such as growth disturbances or joint dysfunction.

Conclusion

In summary, the ICD-10 code S79.14 denotes a Salter-Harris Type IV physeal fracture of the lower end of the femur, characterized by its involvement of the growth plate, epiphysis, and metaphysis. Understanding the implications of this fracture type is critical for effective diagnosis, treatment, and management to ensure optimal outcomes for pediatric patients. Proper follow-up care is essential to monitor for any potential complications related to growth and development.

The Salter-Harris Type IV physeal fracture of the lower end of the femur is a specific type of fracture that occurs in pediatric patients, affecting the growth plate (physeal plate) and the metaphysis and epiphysis of the femur. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this injury is crucial for accurate diagnosis and management.

Clinical Presentation

Patient Characteristics

• Age Group: Salter-Harris Type IV fractures are most commonly seen in children and adolescents, typically between the ages of 5 and 15 years. This age range corresponds with periods of active growth, making the growth plate more susceptible to injury[1].
• Activity Level: These fractures often occur in active children involved in sports or physical activities, where falls or direct trauma to the knee are common[1].

Mechanism of Injury

• Trauma: The most common mechanism for a Salter-Harris Type IV fracture is a high-energy trauma, such as a fall from a height, a motor vehicle accident, or a sports-related injury. The fracture results from a combination of forces that affect the metaphysis, epiphysis, and the growth plate[1][2].

Signs and Symptoms

Pain

• Localized Pain: Patients typically present with significant pain localized to the knee region, which may be exacerbated by movement or weight-bearing activities[1].
• Referred Pain: Pain may also be referred to the thigh or hip, depending on the extent of the injury and associated soft tissue damage[2].

Swelling and Bruising

• Swelling: There is often noticeable swelling around the knee joint, which may develop rapidly following the injury[1].
• Bruising: Ecchymosis (bruising) may be present, indicating soft tissue injury associated with the fracture[2].

Deformity

• Visible Deformity: In some cases, there may be visible deformity of the knee or thigh, particularly if the fracture is displaced. This can manifest as an abnormal alignment of the leg[1].

Limited Range of Motion

• Impaired Mobility: Patients may exhibit a limited range of motion in the knee joint due to pain and swelling. Attempts to move the knee may elicit significant discomfort[2].

Neurological and Vascular Assessment

• Neurovascular Status: It is essential to assess the neurovascular status of the limb, as vascular compromise or nerve injury can occur with significant fractures. Symptoms may include numbness, tingling, or weakness in the lower leg[1].

Diagnosis and Imaging

• Radiographic Evaluation: Diagnosis is typically confirmed through X-rays, which will show the fracture line extending through the growth plate and into the metaphysis and epiphysis. In some cases, advanced imaging such as MRI may be utilized to assess soft tissue involvement or to evaluate the growth plate more thoroughly[2].

Conclusion

Salter-Harris Type IV fractures of the lower end of the femur are significant injuries in pediatric patients that require prompt recognition and management to prevent complications such as growth disturbances. Understanding the clinical presentation, including the characteristic signs and symptoms, is essential for healthcare providers to ensure appropriate treatment and follow-up care. Early intervention can help mitigate long-term consequences associated with these types of fractures, including potential growth plate arrest or deformity[1][2].

The diagnosis of a Salter-Harris Type IV physeal fracture, particularly at the lower end of the femur, is guided by specific criteria outlined in the ICD-10-CM coding system. This classification is crucial for accurately documenting and managing pediatric fractures, as they can significantly impact growth and development.

Understanding Salter-Harris Fractures

Salter-Harris fractures are categorized based on their involvement with the growth plate (physeal plate) and metaphysis. Type IV fractures are characterized by:

• Involvement of the Physis and Metaphysis: These fractures extend through the growth plate (physis) and into the metaphysis, which can affect future bone growth and alignment.
• Common in Pediatric Patients: These fractures are primarily seen in children and adolescents, as their bones are still developing.

Diagnostic Criteria for ICD-10 Code S79.14

The ICD-10 code S79.14 specifically refers to a Salter-Harris Type IV fracture of the lower end of the femur. The criteria for diagnosis include:

1. Clinical Presentation:
   - History of Trauma: A clear history of trauma or injury that could lead to a fracture is essential. This may include falls, sports injuries, or accidents.
   - Symptoms: Patients typically present with pain, swelling, and limited range of motion in the affected knee or thigh area.

2. Physical Examination:
   - Tenderness and Swelling: Localized tenderness over the lower femur and swelling may be observed.
   - Deformity: In some cases, there may be visible deformity or abnormal positioning of the leg.

3. Imaging Studies:
   - X-rays: Radiographic imaging is crucial for diagnosis. X-rays should clearly show:

   • The fracture line extending through the growth plate and into the metaphysis.
   • Any displacement or angulation of the fracture fragments.
   • MRI or CT Scans: In complex cases or when the fracture is not clearly visible on X-rays, advanced imaging techniques may be utilized to assess the extent of the injury.

4. Classification Confirmation:
   - Salter-Harris Classification: The fracture must be classified as Type IV based on the Salter-Harris system, which is determined by the fracture's involvement with the growth plate and metaphysis.

5. Exclusion of Other Conditions:
   - Differential Diagnosis: It is important to rule out other potential injuries, such as ligamentous injuries or other types of fractures, which may present similarly.

Conclusion

Accurate diagnosis of a Salter-Harris Type IV physeal fracture at the lower end of the femur is essential for appropriate management and treatment. The criteria involve a combination of clinical history, physical examination findings, and imaging studies to confirm the fracture type and ensure proper coding under ICD-10. This thorough approach helps in planning treatment strategies that can mitigate the risk of complications related to growth disturbances in pediatric patients.

The ICD-10 code S79.14 specifically refers to a Salter-Harris Type IV physeal fracture of the lower end of the femur. This type of fracture is significant in pediatric orthopedics as it involves the growth plate (physeal) and can affect future growth and development of the bone. Below are alternative names and related terms associated with this condition:

Alternative Names

1. Salter-Harris Type IV Fracture: This is the primary classification name, indicating the fracture's involvement of both the metaphysis and epiphysis.
2. Distal Femoral Physeal Fracture: This term emphasizes the location of the fracture at the distal end of the femur.
3. Growth Plate Fracture: A more general term that refers to any fracture involving the growth plate, which is critical in children and adolescents.
4. Epiphyseal Fracture: This term highlights the involvement of the epiphysis, which is the end part of a long bone.

Related Terms

1. Physeal Injury: A broader term that encompasses any injury to the growth plate, including various types of Salter-Harris fractures.
2. Traumatic Fracture: This term refers to fractures caused by trauma, which is the mechanism behind Salter-Harris fractures.
3. Pediatric Fracture: Since Salter-Harris fractures are primarily seen in children, this term is often used in the context of pediatric orthopedic injuries.
4. Metaphyseal Fracture: This term can be used when discussing the metaphyseal component of the fracture, which is involved in Type IV fractures.

Clinical Context

Salter-Harris fractures are classified into five types based on the involvement of the growth plate and metaphysis. Type IV fractures, such as S79.14, are particularly concerning as they can lead to complications like growth disturbances or deformities if not properly managed. Understanding these alternative names and related terms is crucial for healthcare professionals when diagnosing and treating such injuries.

In summary, the ICD-10 code S79.14 is associated with several alternative names and related terms that reflect its clinical significance and implications in pediatric orthopedic practice.