ICD-10: S82.86

Maisonneuve's fracture, classified under ICD-10 code S82.86, is a specific type of injury characterized by a fracture of the fibula in the lower leg, typically occurring in conjunction with an injury to the ankle. This fracture is named after the French surgeon, Pierre Maisonneuve, who first described it in the 19th century. Understanding the clinical details surrounding this fracture is crucial for accurate diagnosis, treatment, and coding.

Clinical Description

Definition

Maisonneuve's fracture involves a fracture of the fibula, usually located in the proximal third of the bone, and is often associated with a syndesmotic injury at the ankle joint. This injury typically occurs due to an external rotation force applied to the foot, which can lead to instability in the ankle joint and potential complications if not treated properly[1][2].

Mechanism of Injury

The mechanism of injury for a Maisonneuve's fracture often involves:
- Inversion or external rotation of the foot, which can occur during sports activities, falls, or accidents.
- High-energy trauma, such as motor vehicle accidents, can also result in this type of fracture.

Symptoms

Patients with a Maisonneuve's fracture may present with:
- Pain and swelling in the lower leg and ankle.
- Bruising around the ankle joint.
- Inability to bear weight on the affected leg.
- Deformity or abnormal positioning of the ankle may be observed in severe cases.

Diagnosis

Diagnosis typically involves:
- Physical examination to assess pain, swelling, and range of motion.
- Imaging studies, such as X-rays, to confirm the presence of a fibular fracture and to evaluate the integrity of the ankle joint. In some cases, MRI or CT scans may be utilized to assess associated soft tissue injuries or syndesmotic disruptions[3][4].

Treatment

Initial Management

Initial management of a Maisonneuve's fracture may include:
- Rest, ice, compression, and elevation (RICE) to reduce swelling and pain.
- Immobilization of the leg using a splint or cast to prevent further injury.

Surgical Intervention

In cases where there is significant displacement or instability, surgical intervention may be necessary. This can involve:
- Open reduction and internal fixation (ORIF) to realign the fractured fibula and stabilize the ankle joint.
- Syndesmotic screw placement may be required to stabilize the syndesmosis if it is disrupted.

Rehabilitation

Post-surgical rehabilitation is crucial for recovery and may include:
- Physical therapy to restore strength and range of motion.
- Gradual weight-bearing exercises as tolerated.

Coding and Billing

The ICD-10 code S82.86 specifically refers to Maisonneuve's fracture, which is categorized under "Other fractures of lower leg" (S82.8). It is important for healthcare providers to accurately document the specifics of the fracture, including whether it is displaced or non-displaced, as this can affect treatment decisions and billing practices[5][6].

Related Codes

• S82.863K: Displaced Maisonneuve's fracture of unspecified leg, subsequent encounter for closed fracture.
• S82.864M: Non-displaced Maisonneuve's fracture of the right leg, 7th character for the encounter.

Conclusion

Maisonneuve's fracture is a significant injury that requires careful assessment and management to prevent long-term complications. Accurate coding using ICD-10 code S82.86 is essential for effective treatment planning and billing. Understanding the clinical presentation, diagnostic methods, and treatment options is vital for healthcare professionals involved in the care of patients with this type of fracture. Proper rehabilitation following treatment is also crucial to ensure a full recovery and return to normal activities.

[1] ICD-10-CM Code for Maisonneuve's fracture S82.86
[2] ICD-10-CM Diagnosis Code S82.86 - Maisonneuve's fracture
[3] Fibula Fracture - an overview
[4] ICD-10-CM Code for Other fractures of lower leg S82.8
[5] ICD-10-CM Code S82.86 - Maisonneuve's fracture
[6] Billing and Coding: Physical Therapy - Home Health

Maisonneuve's fracture, classified under ICD-10 code S82.86, is a specific type of fibula fracture that occurs in conjunction with an injury to the syndesmosis, which is the fibrous joint connecting the two bones of the lower leg—the tibia and fibula. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this fracture is crucial for accurate diagnosis and effective treatment.

Clinical Presentation

Definition and Mechanism

Maisonneuve's fracture typically results from a high-energy injury, such as a sports-related accident or a fall, where the foot is externally rotated while the leg is fixed. This mechanism leads to a fracture of the fibula, usually in the proximal third, and often involves a tear of the syndesmosis, which can lead to instability in the ankle joint[3][4].

Signs and Symptoms

Patients with Maisonneuve's fracture may present with the following signs and symptoms:

• Pain and Swelling: Severe pain is usually localized to the lateral aspect of the ankle and lower leg, accompanied by significant swelling[3][4].
• Bruising: Ecchymosis may develop around the ankle and along the course of the fibula, indicating soft tissue injury[3].
• Deformity: In some cases, there may be visible deformity or abnormal positioning of the ankle joint, particularly if there is associated dislocation[4].
• Limited Range of Motion: Patients often experience restricted movement in the ankle joint due to pain and swelling, making weight-bearing difficult or impossible[3][4].
• Tenderness: Palpation of the fibula, especially at the fracture site, will elicit tenderness, and there may be tenderness over the syndesmosis area[3].

Patient Characteristics

Maisonneuve's fractures can occur in various patient demographics, but certain characteristics may be more prevalent:

• Age: This type of fracture is commonly seen in younger, active individuals, particularly those engaged in sports or high-impact activities. However, it can also occur in older adults due to falls[3][4].
• Gender: There may be a slight male predominance due to higher participation rates in contact sports and activities that predispose to such injuries[3].
• Activity Level: Patients are often athletes or individuals involved in physically demanding occupations or recreational activities that increase the risk of ankle injuries[4].

Conclusion

Maisonneuve's fracture is a significant injury that requires prompt recognition and management to prevent complications such as chronic pain or instability in the ankle. The clinical presentation typically includes severe pain, swelling, and tenderness around the ankle and fibula, with a mechanism of injury often involving external rotation of the foot. Understanding the signs, symptoms, and patient characteristics associated with this fracture is essential for healthcare providers to ensure appropriate treatment and rehabilitation strategies are implemented.

Maisonneuve's fracture, classified under ICD-10 code S82.86, is a specific type of injury that involves a fracture of the fibula, typically associated with an injury to the ankle. Understanding alternative names and related terms can enhance clarity in medical documentation and communication. Here’s a detailed overview:

Alternative Names for Maisonneuve's Fracture

1. Fibular Fracture: This term broadly refers to any fracture of the fibula, but it can specifically denote a Maisonneuve's fracture when associated with ankle injuries.

2. Proximal Fibula Fracture: This term emphasizes the location of the fracture, which occurs near the top of the fibula, often linked to syndesmotic injuries.

3. Syndesmotic Injury: While not a direct synonym, this term is often used in conjunction with Maisonneuve's fracture, as the injury typically involves damage to the syndesmosis, the fibrous joint between the tibia and fibula.

4. Ankle Fracture: Although this term is more general, it can sometimes refer to the associated injuries that occur with a Maisonneuve's fracture.

Related Terms

1. Inversion Injury: This term describes the mechanism of injury that often leads to a Maisonneuve's fracture, where the foot rolls inward, causing stress on the fibula.

2. Distal Tibiofibular Syndesmosis Injury: This term refers to the injury of the fibrous joint connecting the tibia and fibula, which is commonly affected in Maisonneuve's fractures.

3. Lateral Malleolus Fracture: This term refers to fractures of the outer ankle bone, which can occur alongside a Maisonneuve's fracture.

4. Bimalleolar Fracture: This term describes fractures involving both the medial and lateral malleoli, which may occur in conjunction with a Maisonneuve's fracture.

5. Trimalleolar Fracture: This term refers to fractures involving all three malleoli (the lateral, medial, and posterior), which can also be associated with Maisonneuve's fractures.

Conclusion

Understanding the alternative names and related terms for Maisonneuve's fracture is crucial for accurate diagnosis, treatment, and documentation in medical settings. These terms help clarify the nature of the injury and its implications for patient care. When discussing or coding for this type of fracture, using the correct terminology ensures effective communication among healthcare professionals and aids in the appropriate management of the injury.

Maisonneuve's fracture, classified under ICD-10 code S82.86, is a specific type of injury that involves a fracture of the fibula, typically occurring in conjunction with an injury to the ankle. The diagnosis of this fracture is based on a combination of clinical evaluation and imaging studies. Below are the key criteria used for diagnosing a Maisonneuve's fracture:

Clinical Presentation

1. Mechanism of Injury:
   - Maisonneuve's fractures often result from a high-energy injury, such as a twisting motion of the ankle or a fall. This mechanism typically leads to both a fibular fracture and an injury to the syndesmosis, which is the fibrous joint connecting the two bones of the lower leg (tibia and fibula) [1].

2. Symptoms:
   - Patients may present with significant pain and swelling around the ankle and lower leg. There may also be bruising and tenderness along the fibula, particularly at the site of the fracture [1].

3. Physical Examination:
   - A thorough physical examination is crucial. The clinician will assess for tenderness, swelling, and any deformity in the ankle and lower leg. The range of motion may be limited due to pain [1].

Imaging Studies

1. X-rays:
   - Standard X-rays of the ankle and lower leg are the first-line imaging studies. They can reveal the presence of a fibular fracture, typically located in the proximal third of the fibula, and may also show any associated ankle joint involvement [2].

2. CT or MRI:
   - In cases where X-rays are inconclusive or if there is a suspicion of associated injuries (such as syndesmotic injury), a CT scan or MRI may be performed. These imaging modalities provide a more detailed view of the fibula and the ankle joint, helping to confirm the diagnosis and assess the extent of the injury [2][3].

Diagnostic Criteria Summary

• Presence of a fibular fracture: Confirmed through imaging.
• Associated ankle injury: Often seen in conjunction with the fibular fracture.
• Mechanism of injury: Consistent with a twisting or high-energy trauma.
• Clinical symptoms: Pain, swelling, and tenderness in the affected area.

Conclusion

Diagnosing a Maisonneuve's fracture involves a combination of clinical assessment and imaging studies to confirm the presence of a fibular fracture and any associated injuries. Proper diagnosis is essential for effective treatment and rehabilitation, as this type of fracture can lead to complications if not managed appropriately. If you suspect a Maisonneuve's fracture, it is crucial to seek medical evaluation promptly to ensure accurate diagnosis and treatment [1][2][3].

Maisonneuve's fracture, classified under ICD-10 code S82.86, is a specific type of fibula fracture that occurs in conjunction with an injury to the syndesmosis, the fibrous joint connecting the two bones of the lower leg (the tibia and fibula). This injury typically results from a forceful external rotation of the ankle, leading to both a fracture of the fibula and potential disruption of the ankle joint. Understanding the standard treatment approaches for this condition is crucial for effective recovery.

Initial Assessment and Diagnosis

Before treatment can begin, a thorough assessment is essential. This typically includes:

• Clinical Examination: Evaluating the patient's history and symptoms, including pain, swelling, and any deformity in the ankle or lower leg.
• Imaging Studies: X-rays are the primary imaging modality used to confirm the diagnosis of a Maisonneuve fracture. In some cases, a CT scan may be necessary to assess the extent of the injury and any associated syndesmotic injury[1].

Standard Treatment Approaches

Non-Surgical Management

In cases where the fracture is stable and there is no significant displacement or syndesmotic injury, non-surgical treatment may be appropriate. This typically involves:

• Immobilization: The affected limb is usually immobilized using a cast or a splint to prevent movement and allow for healing. The duration of immobilization can vary but typically lasts for 6 to 8 weeks[1].
• Weight Bearing: Patients may be advised to avoid weight-bearing activities initially. Gradual weight bearing can be introduced as healing progresses, often guided by follow-up imaging and clinical assessment[1].
• Physical Therapy: Once the initial healing phase is complete, physical therapy may be recommended to restore range of motion, strength, and function to the ankle and lower leg[1].

Surgical Management

Surgical intervention is often required in cases of:

• Displaced Fractures: If the fibula fracture is significantly displaced, surgical fixation may be necessary to realign the bones and stabilize the fracture.
• Syndesmotic Injury: If there is a disruption of the syndesmosis, surgical repair may involve the use of screws or other fixation devices to stabilize the joint[1][2].

The surgical procedure typically includes:

• Open Reduction and Internal Fixation (ORIF): This technique involves surgically exposing the fracture site, realigning the bones, and securing them with plates and screws. This approach is often used for both the fibula fracture and any associated syndesmotic injury[2].
• Postoperative Care: After surgery, the patient will usually be placed in a cast or boot and may require crutches to assist with mobility. Follow-up appointments are essential to monitor healing and adjust rehabilitation protocols as needed[2].

Rehabilitation

Rehabilitation is a critical component of recovery from a Maisonneuve fracture. It typically includes:

• Gradual Return to Activity: Patients are guided through a structured rehabilitation program that gradually increases activity levels, focusing on restoring strength, flexibility, and balance.
• Monitoring for Complications: Regular follow-ups are necessary to ensure proper healing and to address any complications, such as non-union or malunion of the fracture[1][2].

Conclusion

The treatment of Maisonneuve fractures involves a careful assessment of the injury and a tailored approach based on the stability of the fracture and the presence of any associated injuries. While non-surgical management is effective for stable fractures, surgical intervention may be necessary for more complex cases. Rehabilitation plays a vital role in ensuring a full recovery, allowing patients to return to their normal activities safely. Regular follow-up care is essential to monitor healing and prevent complications.