ICD-10: S79.142

Salter-Harris Type IV physeal fractures are significant injuries that occur in children and adolescents, affecting the growth plate (physeal plate) of long bones. The ICD-10 code S79.142 specifically refers to a Salter-Harris Type IV fracture at the lower end of the left femur. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this type of fracture is crucial for effective diagnosis and management.

Clinical Presentation

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 metaphysis, physis, and epiphysis, which can lead to complications such as growth disturbances or joint deformities if not properly treated[1].

Common Patient Characteristics

• Age Group: Typically occurs in children and adolescents, as their bones are still growing. The average age for such injuries is often between 10 to 16 years[2].
• Activity Level: These fractures are commonly associated with high-energy trauma, such as sports injuries, falls, or accidents[3].
• Gender: Males are more frequently affected than females, likely due to higher participation in contact sports and risk-taking behaviors[4].

Signs and Symptoms

Clinical Signs

• Swelling and Bruising: Localized swelling and bruising around the knee or thigh area may be evident due to soft tissue injury accompanying the fracture[5].
• Deformity: There may be visible deformity of the knee or thigh, particularly if the fracture is displaced[6].
• Tenderness: Palpation of the area will likely elicit tenderness, especially over the fracture site.

Symptoms

• Pain: Patients typically report significant pain in the thigh or knee, which may worsen with movement or weight-bearing activities[7].
• Limited Range of Motion: There may be a noticeable decrease in the range of motion in the knee joint due to pain and swelling[8].
• Inability to Bear Weight: Patients often cannot bear weight on the affected leg, leading to a limp or inability to walk[9].

Diagnosis

Imaging Studies

• X-rays: Standard radiographs are the first-line imaging modality to confirm the diagnosis. X-rays will show the fracture line extending through the metaphysis, physis, and epiphysis[10].
• MRI or CT Scans: In some cases, advanced imaging may be required to assess the extent of the injury and to evaluate for associated soft tissue injuries[11].

Conclusion

Salter-Harris Type IV physeal fractures of the lower end of the left femur present with distinct clinical features, including significant pain, swelling, and potential deformity. These injuries are primarily seen in active children and adolescents, often resulting from high-energy trauma. Prompt diagnosis and appropriate management are essential to prevent complications such as growth disturbances. If you suspect a Salter-Harris Type IV fracture, it is crucial to seek medical evaluation for proper treatment and follow-up care.

The ICD-10 code S79.142 refers specifically to a Salter-Harris Type IV physeal fracture of the lower end of the left femur. This type of fracture is significant in pediatric orthopedics as it involves the growth plate (physeal plate) and can affect future growth and development of the bone. Below are alternative names and related terms associated with this specific fracture type:

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. Growth Plate Fracture: A more general term that describes any fracture involving the growth plate, which is critical in children.
3. Epiphyseal Fracture: This term emphasizes the fracture's location at the end of the bone, where the epiphysis is situated.
4. Metaphyseal Fracture: This term highlights the involvement of the metaphysis, the region of the bone adjacent to the growth plate.

Related Terms

1. Physeal Injury: A broader term that encompasses any injury to the growth plate, including fractures.
2. Pediatric Fracture: Since Salter-Harris fractures are primarily seen in children, this term is often used in discussions about fractures in this age group.
3. Fracture Classification: Refers to the system used to categorize fractures, including the Salter-Harris classification system.
4. Traumatic Fracture: A general term for fractures caused by trauma, which can include Salter-Harris fractures.
5. Lower Extremity Fracture: This term categorizes fractures occurring in the lower limb, including the femur.

Clinical Context

Salter-Harris fractures are classified into five types based on the involvement of the growth plate and metaphysis. Type IV fractures, like the one indicated by S79.142, are particularly concerning due to their potential impact on bone growth and alignment. Proper diagnosis and treatment are crucial to prevent complications such as limb length discrepancies or angular deformities.

Understanding these alternative names and related terms can aid healthcare professionals in accurately communicating about the injury and its implications for treatment and recovery.

The ICD-10 code S79.142 refers specifically to a Salter-Harris Type IV physeal fracture of the lower end of the left femur. Understanding this diagnosis requires a detailed look at both the Salter-Harris classification and the implications of such a fracture.

Overview of Salter-Harris Fractures

Salter-Harris fractures are a classification system used to describe fractures that involve the growth plate (physeal plate) in children and adolescents. These fractures are critical to identify because they can affect future growth and bone development. The Salter-Harris classification includes five types:

• 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 through the metaphysis, growth plate, and epiphysis.
• Type V: Compression fracture of the growth plate.

A Salter-Harris Type IV fracture, such as the one denoted by S79.142, involves a fracture that crosses through both the metaphysis and epiphysis, which can lead to complications in growth and development if not treated properly[1].

Clinical Description of S79.142

Location and Mechanism of Injury

The lower end of the femur, located just above the knee joint, is a common site for such fractures, particularly in pediatric populations. These injuries often result from high-energy trauma, such as falls from a height, sports injuries, or vehicular accidents. The mechanism of injury typically involves a force that causes bending or twisting of the bone, leading to a fracture that disrupts the growth plate[2].

Symptoms and Diagnosis

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

• Pain and Swelling: Localized pain around the knee and swelling in the area of the fracture.
• Decreased Range of Motion: Difficulty in moving 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 typically confirmed through imaging studies, such as X-rays, which can reveal the fracture line and its involvement with the growth plate. In some cases, MRI may be used to assess the extent of the injury and any associated soft tissue damage[3].

Treatment Considerations

Treatment for a Salter-Harris Type IV fracture often involves:

• Reduction: If the fracture is displaced, a closed or open reduction may be necessary to realign the bone fragments.
• Stabilization: Internal fixation with pins, screws, or plates may be required to maintain proper alignment during healing.
• Rehabilitation: Post-surgical rehabilitation is crucial to restore function and strength to the affected limb.

Prognosis

The prognosis for a Salter-Harris Type IV fracture largely depends on the adequacy of the treatment and the age of the patient. If treated appropriately, many patients can expect a good functional outcome, although there is a risk of growth disturbances or angular deformities in the future due to the involvement of the growth plate[4].

Conclusion

In summary, the ICD-10 code S79.142 identifies a Salter-Harris Type IV physeal fracture of the lower end of the left femur, a significant injury that requires careful diagnosis and management to prevent long-term complications. Understanding the nature of this fracture and its implications is essential for healthcare providers involved in pediatric orthopedics and trauma care.

[1] Salter-Harris fracture classification overview.
[2] Mechanisms of injury for pediatric femoral fractures.
[3] Diagnostic imaging for Salter-Harris fractures.
[4] Treatment and prognosis of Salter-Harris fractures.

The ICD-10 code S79.142A refers specifically to a Salter-Harris Type IV physeal fracture of the lower end of the left femur. Understanding the criteria for diagnosing this type of fracture involves a combination of clinical evaluation, imaging studies, and an understanding of the Salter-Harris classification system.

Understanding Salter-Harris Fractures

Salter-Harris fractures are classified into five types based on the involvement of the growth plate (physis) and metaphysis. Type IV fractures, such as S79.142A, are characterized by:

• Involvement of the Physis and Metaphysis: This type of fracture extends through the growth plate and into the metaphysis, which can affect future growth and development of the bone.
• Common in Pediatric Patients: These fractures are primarily seen in children and adolescents, as their growth plates are still open.

Diagnostic Criteria

Clinical Evaluation

1. History of Trauma: The patient typically presents with a history of trauma, such as a fall or direct impact to the knee or thigh area.
2. Symptoms: Common symptoms include:
   - Pain localized to the knee or thigh.
   - Swelling and tenderness around the knee joint.
   - Limited range of motion in the affected leg.
   - Possible deformity or abnormal positioning of the leg.

Physical Examination

• Inspection: Look for swelling, bruising, or deformity in the knee or thigh region.
• Palpation: Assess for tenderness over the femur and knee joint.
• Range of Motion: Evaluate the range of motion in the knee and hip joints, noting any limitations or pain.

Imaging Studies

1. X-rays: The primary imaging modality for diagnosing Salter-Harris fractures. X-rays should be taken in multiple views (anteroposterior and lateral) to visualize the fracture line and assess the involvement of the growth plate.
   - Fracture Line: In a Type IV fracture, the fracture line will traverse the growth plate and extend into the metaphysis.
   - Displacement: Look for any displacement of the fracture fragments, which can indicate the severity of the injury.

2. MRI or CT Scans: In some cases, advanced imaging may be required to assess the extent of the fracture, especially if there is suspicion of associated soft tissue injury or if the fracture is not clearly visible on X-rays.

Additional Considerations

• Age of the Patient: Since Salter-Harris fractures are specific to children, the age of the patient is a critical factor in diagnosis.
• Growth Plate Assessment: Understanding the status of the growth plate is essential, as injuries to this area can impact future bone growth and development.

Conclusion

Diagnosing a Salter-Harris Type IV physeal fracture of the lower end of the left femur (ICD-10 code S79.142A) involves a thorough clinical assessment, careful physical examination, and appropriate imaging studies. The combination of these elements helps ensure accurate diagnosis and effective management of the injury, which is crucial for preventing potential complications related to growth disturbances in pediatric patients. If you suspect such an injury, prompt evaluation by a healthcare professional is essential for optimal outcomes.

Salter-Harris Type IV physeal fractures are significant injuries that involve the growth plate (physis) and metaphysis of a bone, particularly in children and adolescents. The ICD-10 code S79.142 specifically refers to a Salter-Harris Type IV fracture of the lower end of the left 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 physis and metaphysis, which can potentially disrupt normal growth if not treated properly. The lower end of the femur is particularly important for knee function and overall leg length.

Standard Treatment Approaches

1. Initial Assessment and Diagnosis

• Clinical Evaluation: A thorough physical examination is essential to assess the extent of the injury, including checking for swelling, deformity, and range of motion.
• Imaging Studies: X-rays are typically the first imaging modality used to confirm the diagnosis. In some cases, MRI may be utilized to assess soft tissue involvement or to evaluate the growth plate more clearly.

2. Non-Surgical Management

• Immobilization: In cases where the fracture is stable and there is no significant displacement, conservative treatment may be appropriate. This typically involves immobilization with a cast or splint to allow for healing.
• Follow-Up: Regular follow-up appointments are necessary to monitor healing and ensure that the fracture is not affecting growth.

3. Surgical Intervention

• Indications for Surgery: If the fracture is displaced or unstable, surgical intervention is often required to realign the bone fragments and stabilize the fracture.
• Surgical Techniques: Common surgical methods include:
  • Open Reduction and Internal Fixation (ORIF): This involves surgically realigning the fracture and using hardware (such as plates and screws) to maintain proper alignment during healing.
  • Intramedullary Nailing: In some cases, especially in older children or adolescents, intramedullary nails may be used to stabilize the fracture.
• Postoperative Care: After surgery, the patient will typically require a period of immobilization followed by rehabilitation to restore function.

4. Rehabilitation

• Physical Therapy: Once the fracture has stabilized, physical therapy is crucial to regain strength, flexibility, and range of motion. This may include exercises tailored to the individual’s needs and the specifics of the injury.
• Monitoring Growth: Given the potential impact on growth, ongoing monitoring of the affected limb is essential. This may involve periodic X-rays to assess the growth plate and ensure that normal growth patterns are maintained.

5. Complications and Long-Term Considerations

• Growth Disturbances: One of the primary concerns with Salter-Harris Type IV fractures is the risk of growth disturbances, which can lead to limb length discrepancies or angular deformities.
• Osteonecrosis: There is also a risk of osteonecrosis of the femoral head, particularly if the blood supply is compromised during the injury or surgical intervention.
• Long-Term Follow-Up: Patients may require long-term follow-up to monitor for any late complications, including joint function and growth issues.

Conclusion

The management of a Salter-Harris Type IV physeal fracture of the lower end of the left femur involves a careful balance of immediate treatment, surgical intervention when necessary, and long-term monitoring to ensure proper healing and growth. Early diagnosis and appropriate treatment are critical to minimize complications and support optimal recovery. Regular follow-ups with healthcare providers are essential to address any potential issues that may arise during the healing process.