ICD-10: S82.861

The ICD-10 code S82.861 refers specifically to a displaced Maisonneuve's fracture of the right leg. This type of fracture is characterized by a specific mechanism of injury and has distinct clinical implications. Below is a detailed overview of the clinical description, associated features, and management considerations for this condition.

Clinical Description

Definition

A Maisonneuve fracture is a type of injury that involves a fracture of the fibula, typically occurring in the upper part of the bone, near the knee. It is often associated with an injury to the syndesmosis, which is the fibrous joint connecting the two bones of the lower leg (the tibia and fibula). The term "displaced" indicates that the fracture fragments have moved out of their normal alignment, which can complicate treatment and recovery.

Mechanism of Injury

Maisonneuve fractures usually occur due to a forceful external rotation of the foot combined with an axial load. This can happen in various scenarios, such as during sports activities, falls, or accidents. The injury often results from a twisting motion that places stress on the ankle and lower leg.

Symptoms

Patients with a displaced Maisonneuve fracture may present with:
- Severe pain in the lower leg, particularly around the ankle and fibula.
- Swelling and bruising in the affected area.
- Inability to bear weight on the injured leg.
- Deformity or abnormal positioning of the leg may be visible in severe cases.

Diagnosis

Imaging Studies

Diagnosis typically involves:
- X-rays: These are essential for visualizing the fracture and assessing its displacement. X-rays can also help identify any associated injuries to the ankle joint.
- CT scans or MRI: In some cases, these imaging modalities may be used to evaluate the extent of the injury, particularly if there is suspicion of syndesmotic injury or if the fracture is not clearly visible on X-rays.

Treatment

Initial Management

The initial management of a displaced Maisonneuve fracture includes:
- Immobilization: The leg is often immobilized using a splint or cast to prevent further movement and allow for healing.
- Pain management: Analgesics are prescribed to manage pain effectively.

Surgical Intervention

In cases where the fracture is significantly displaced or if there is instability in the ankle joint, surgical intervention may be necessary. This can involve:
- Open reduction and internal fixation (ORIF): This procedure realigns the fractured bones and secures them with plates and screws.
- Syndesmotic stabilization: If the syndesmosis is injured, additional stabilization may be required to ensure proper healing.

Rehabilitation

Post-surgery or after immobilization, rehabilitation is crucial. This may include:
- Physical therapy: To restore range of motion, strength, and function.
- Gradual weight-bearing: Patients are typically advised to gradually increase weight-bearing activities as healing progresses.

Prognosis

The prognosis for a displaced Maisonneuve fracture is generally good, especially with appropriate treatment. However, complications such as chronic pain, instability, or arthritis in the ankle joint can occur if the injury is not managed properly.

In summary, the ICD-10 code S82.861 identifies a specific and significant injury that requires careful diagnosis and management to ensure optimal recovery and function. Early intervention and appropriate treatment strategies are essential for minimizing complications and promoting healing.

Displaced Maisonneuve's fracture, classified under ICD-10 code S82.861, is a specific type of injury that involves both the fibula and the syndesmosis of the ankle. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for accurate diagnosis and effective management.

Clinical Presentation

Definition and Mechanism of Injury

A Maisonneuve fracture is characterized by a fracture of the fibula, typically occurring in the proximal third, accompanied by an injury to the syndesmosis, which is the fibrous joint connecting the two bones of the lower leg (the tibia and fibula). This injury often results from a combination of external rotation and ankle eversion, commonly seen in sports injuries or falls[1].

Patient Characteristics

Patients who sustain a Maisonneuve fracture often share certain characteristics:
- Age: This injury is more prevalent in younger individuals, particularly those aged 15 to 30 years, due to higher activity levels and participation in sports[1].
- Gender: Males are more frequently affected than females, likely due to higher engagement in high-risk activities[1].
- Activity Level: Individuals involved in sports or activities that require sudden changes in direction or jumping are at increased risk[1].

Signs and Symptoms

Common Symptoms

Patients with a displaced Maisonneuve fracture typically present with the following symptoms:
- Pain: Severe pain in the lateral aspect of the ankle and lower leg, which may worsen with movement or weight-bearing[1].
- Swelling: Significant swelling around the ankle and possibly extending up the leg, indicating soft tissue injury[1].
- Bruising: Ecchymosis may develop around the ankle and along the fibula, reflecting the extent of the injury[1].

Physical Examination Findings

During a physical examination, healthcare providers may observe:
- Deformity: Visible deformity of the ankle or lower leg, particularly if the fracture is displaced[1].
- Tenderness: Localized tenderness over the fibula and the syndesmosis area, which may indicate instability[1].
- Range of Motion: Limited range of motion in the ankle joint, with pain exacerbated by attempts to move the foot[1].

Complications

Complications can arise from a Maisonneuve fracture, including:
- Syndesmotic Injury: Damage to the syndesmosis can lead to chronic instability of the ankle if not properly addressed[1].
- Nonunion or Malunion: Improper healing of the fracture may result in persistent pain and functional impairment[1].

Conclusion

In summary, a displaced Maisonneuve fracture of the right leg (ICD-10 code S82.861) is a significant injury that requires prompt recognition and management. Patients typically present with severe pain, swelling, and tenderness, particularly in the lateral ankle region. Understanding the clinical presentation, signs, symptoms, and patient characteristics is essential for healthcare providers to ensure appropriate treatment and rehabilitation, ultimately leading to better patient outcomes. Early intervention can help prevent complications such as chronic instability or nonunion of the fracture.

The ICD-10 code S82.861 specifically refers to a displaced Maisonneuve's fracture of the right leg. This type of fracture is characterized by a fracture of the fibula in the lower leg, typically associated with an injury to the syndesmosis, which is the fibrous joint connecting the two bones of the lower leg (the tibia and fibula). Below are alternative names and related terms associated with this condition:

Alternative Names

1. Maisonneuve Fracture: This is the primary term used to describe the injury, named after the French surgeon who first described it.
2. Fibular Fracture: While this term is broader, it can refer to the specific type of fibular fracture that occurs in a Maisonneuve injury.
3. Syndesmotic Injury: This term highlights the associated injury to the syndesmosis, which is a critical aspect of the Maisonneuve fracture.

Related Terms

1. Displaced Fracture: This term indicates that the bone fragments have moved out of their normal alignment, which is a key characteristic of the Maisonneuve fracture.
2. Ankle Fracture: Although not synonymous, this term is often related since Maisonneuve fractures can occur alongside ankle injuries.
3. Tibiofibular Syndesmosis Injury: This term refers to the injury of the fibrous joint between the tibia and fibula, which is often involved in Maisonneuve fractures.
4. Lower Leg Fracture: A general term that encompasses fractures occurring in the lower leg, including Maisonneuve fractures.

Clinical Context

Understanding these terms is essential for healthcare professionals when diagnosing and treating patients with this type of fracture. The Maisonneuve fracture is significant due to its potential complications, including instability of the ankle joint and the need for surgical intervention in some cases.

In summary, the Maisonneuve fracture is a specific type of displaced fibular fracture that is closely associated with syndesmotic injuries, and it is important to recognize the various terms that may be used in clinical settings to describe this condition.

Displaced Maisonneuve's fracture is a specific type of injury that involves a fracture of the fibula, typically occurring in conjunction with an injury to the syndesmosis of the ankle. The diagnosis of this condition, particularly under the ICD-10 code S82.861, requires a thorough understanding of the clinical criteria and diagnostic imaging findings. Below, we explore the criteria used for diagnosing this fracture.

Clinical Presentation

Symptoms

Patients with a displaced Maisonneuve's fracture often present with:
- Pain: Severe pain in the lower leg, particularly around the ankle and lateral aspect of the leg.
- Swelling: Noticeable swelling around the ankle and possibly the mid-portion of the leg.
- Bruising: Ecchymosis may be present, indicating soft tissue injury.
- Inability to bear weight: Patients typically have difficulty or are unable to bear weight on the affected leg.

Mechanism of Injury

The injury usually occurs due to:
- External rotation: Often resulting from a fall or sports-related injury where the foot is planted, and the body rotates.
- Inversion or eversion: These movements can also contribute to the fracture pattern.

Diagnostic Imaging

X-rays

• Standard X-rays: Initial imaging typically includes anteroposterior (AP) and lateral views of the ankle and leg. The presence of a fibular fracture above the level of the ankle joint is indicative of a Maisonneuve fracture.
• Syndesmotic injury: X-rays may also show widening of the syndesmosis, which is critical for confirming the diagnosis.

Advanced Imaging

• MRI or CT scans: In cases where the injury is complex or if there is suspicion of associated ligamentous injuries, advanced imaging may be utilized to assess the extent of the injury and any potential complications.

Diagnostic Criteria

To diagnose a displaced Maisonneuve's fracture accurately, the following criteria are typically considered:
1. Clinical examination: Assessment of pain, swelling, and functional impairment.
2. Radiographic evidence: Identification of a fibular fracture above the ankle joint, along with any signs of syndesmotic injury.
3. Exclusion of other injuries: Ensuring that other potential injuries, such as fractures of the tibia or ankle, are ruled out.

Conclusion

The diagnosis of a displaced Maisonneuve's fracture (ICD-10 code S82.861) relies on a combination of clinical evaluation and imaging studies. The presence of characteristic symptoms, coupled with specific findings on X-rays or advanced imaging, confirms the diagnosis. Proper identification and management of this injury are crucial to prevent long-term complications, such as chronic ankle instability or post-traumatic arthritis. If you have further questions or need additional information on treatment options, feel free to ask!

Displaced Maisonneuve's fracture, classified under ICD-10 code S82.861, refers to a specific type of fracture involving the fibula and often associated with an injury to the syndesmosis of the ankle. This injury typically occurs due to a high-energy trauma, such as a sports injury or a fall, and requires careful management to ensure proper healing and function.

Overview of Maisonneuve's Fracture

A Maisonneuve fracture is characterized by a fracture of the fibula, typically occurring in the proximal third of the bone, along with a disruption of the syndesmosis, which is the fibrous joint connecting the tibia and fibula. This injury can lead to instability in the ankle joint if not treated appropriately[1].

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, tenderness, and range of motion.
• Imaging Studies: X-rays are the primary imaging modality used to confirm the diagnosis and assess the displacement of the fracture. In some cases, a CT scan may be necessary for a more detailed evaluation of the fracture and associated injuries[2].

2. Non-Surgical Management

• Indications: Non-surgical treatment is typically considered for stable fractures without significant displacement or syndesmotic injury.
• Immobilization: The affected leg is usually immobilized using a cast or a splint for a period of 6-8 weeks. This helps to stabilize the fracture and allows for healing.
• Weight Bearing: Patients may be advised to avoid weight-bearing activities initially, transitioning to partial weight-bearing as healing progresses, guided by follow-up imaging and clinical assessment[3].

3. Surgical Management

• Indications: Surgical intervention is indicated for displaced fractures, particularly when there is significant instability or involvement of the syndesmosis.
• Surgical Techniques: The most common surgical procedure involves open reduction and internal fixation (ORIF) of the fibula. This may include the use of plates and screws to stabilize the fracture.
• Syndesmotic Repair: If there is a syndesmotic injury, additional procedures such as syndesmotic screw fixation may be performed to restore the integrity of the ankle joint[4].

4. Rehabilitation

• Physical Therapy: After immobilization or surgical fixation, a structured rehabilitation program is crucial. This typically includes:
  • Range of motion exercises to prevent stiffness.
  • Strengthening exercises to restore muscle function.
  • Balance and proprioception training to enhance stability and prevent future injuries[5].
• Gradual Return to Activity: Patients are gradually guided back to their normal activities, including sports, based on their recovery progress and functional assessments.

5. Follow-Up Care

• Regular follow-up appointments are essential to monitor healing through clinical evaluation and repeat imaging. This ensures that any complications, such as non-union or malunion, are identified and managed promptly[6].

Conclusion

The management of a displaced Maisonneuve's fracture involves a comprehensive approach that includes accurate diagnosis, appropriate treatment (either non-surgical or surgical), and a structured rehabilitation program. Early intervention and adherence to follow-up care are critical to achieving optimal outcomes and restoring function to the affected leg. If you suspect a Maisonneuve fracture, it is essential to seek medical attention promptly to ensure the best possible recovery.