ICD-10: S99.04

The ICD-10 code S99.04 refers specifically to a Salter-Harris Type IV physeal fracture of the calcaneus. This classification is crucial for accurately diagnosing and coding injuries related to the growth plates in children and adolescents, particularly in the context of foot injuries.

Clinical Description

Salter-Harris Classification

The Salter-Harris classification system categorizes fractures that involve the growth plate (physeal fractures) into five types, with Type IV being particularly significant. A Salter-Harris Type IV fracture extends through the metaphysis, physis, and epiphysis, which can potentially affect the growth of the bone if not treated properly. This type of fracture is often associated with significant trauma and can lead to complications such as growth disturbances or deformities if not managed appropriately[1][2].

Physeal Fracture of the Calcaneus

The calcaneus, or heel bone, is the largest bone in the foot and plays a critical role in weight-bearing and movement. A physeal fracture in this area can occur due to various mechanisms, including falls, sports injuries, or accidents. Symptoms typically include:

• Localized pain: Often severe and exacerbated by movement or pressure.
• Swelling and bruising: Around the heel and ankle area.
• Difficulty bearing weight: Patients may find it painful or impossible to walk or stand on the affected foot.
• Deformity: In some cases, there may be visible deformity or misalignment of the heel.

Diagnosis and Imaging

Diagnosis of a Salter-Harris Type IV fracture typically involves a thorough clinical examination and imaging studies. X-rays are the primary imaging modality used to confirm the fracture and assess its type. In some cases, advanced imaging such as MRI or CT scans may be utilized to evaluate the extent of the injury and any associated soft tissue damage[3][4].

Treatment Considerations

Management of a Salter-Harris Type IV fracture of the calcaneus often requires a multidisciplinary approach, including:

• Immobilization: The affected foot may be placed in a cast or splint to prevent movement and allow for healing.
• Surgical intervention: In cases where the fracture is displaced or unstable, surgical fixation may be necessary to realign the bone fragments and stabilize the growth plate.
• Rehabilitation: Post-treatment, physical therapy is often recommended to restore function, strength, and range of motion to the affected foot.

Prognosis

The prognosis for a Salter-Harris Type IV fracture largely depends on the severity of the fracture, the age of the patient, and the timeliness of treatment. With appropriate management, many patients can expect a good recovery, although there is a risk of complications such as growth arrest or deformity, which may require further intervention[5][6].

Conclusion

In summary, the ICD-10 code S99.04 identifies a Salter-Harris Type IV physeal fracture of the calcaneus, a significant injury that necessitates careful diagnosis and management to prevent long-term complications. Understanding the implications of this injury is essential for healthcare providers involved in pediatric orthopedics and trauma care.

References

1. ICD-10-CM Diagnosis Code S99.04: Salter-Harris Type IV physeal fracture of calcaneus.
2. Salter-Harris Type IV physeal fracture of calcaneus - ICD-10.
3. Physeal fracture of calcaneus S99.0 - The Web's Free 2023 ICD-10-CM.
4. Other and unspecified injuries of ankle and foot (S99) - ICD List.
5. 2025 ICD-10-CM Diagnosis Code S99.04: Salter-Harris Type IV physeal fracture of calcaneus.
6. ICD-10 Code for Salter-Harris Type IV physeal fracture of right calcaneus - AAPC.

Salter-Harris Type IV physeal fractures, particularly of the calcaneus, are significant injuries that can affect pediatric patients. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this type of fracture is crucial for effective diagnosis and management.

Overview of Salter-Harris Type IV Fractures

Salter-Harris fractures are classified into five types based on the involvement of the growth plate (physis) and metaphysis. Type IV fractures extend through the physis and metaphysis, which can lead to complications such as growth disturbances if not properly treated[3][4]. The calcaneus, or heel bone, is a common site for these fractures in children, often resulting from falls or high-impact injuries.

Clinical Presentation

Signs and Symptoms

1. Pain and Tenderness: Patients typically present with localized pain in the heel area, which may be exacerbated by movement or pressure[6].
2. Swelling and Bruising: Swelling around the heel and ankle is common, often accompanied by bruising due to soft tissue injury[5].
3. Limited Range of Motion: Patients may exhibit restricted movement in the ankle and foot, particularly when attempting to bear weight[4].
4. Deformity: In some cases, there may be visible deformity or misalignment of the heel, especially if the fracture is displaced[6].

Additional Symptoms

• Inability to Bear Weight: Children may refuse to walk or put weight on the affected foot due to pain[5].
• Altered Gait: If the child attempts to walk, they may exhibit an abnormal gait pattern, favoring the uninjured side[4].

Patient Characteristics

Demographics

• Age: Salter-Harris Type IV fractures are most commonly seen in children and adolescents, typically between the ages of 5 and 15 years[3][6].
• Activity Level: These fractures often occur in active children who participate in sports or activities with a higher risk of falls or trauma[4].

Risk Factors

• Previous Injuries: A history of prior fractures or injuries may increase susceptibility to new fractures[5].
• Bone Health: Conditions affecting bone density, such as osteogenesis imperfecta, can predispose children to fractures[6].

Diagnosis

Diagnosis of a Salter-Harris Type IV fracture typically involves a combination of clinical evaluation and imaging studies. X-rays are the primary imaging modality used to confirm the fracture and assess its type and displacement[3][4]. In some cases, advanced imaging such as MRI may be warranted to evaluate associated soft tissue injuries or to assess the growth plate more thoroughly.

Conclusion

Salter-Harris Type IV physeal fractures of the calcaneus are serious injuries that require prompt recognition and management to prevent long-term complications, including growth disturbances. Clinicians should be vigilant in assessing the clinical presentation, signs, and symptoms, as well as understanding the patient characteristics that may influence treatment outcomes. Early intervention and appropriate treatment strategies are essential for optimal recovery and return to normal activities.

The ICD-10 code S99.04 specifically refers to a Salter-Harris Type IV physeal fracture of the calcaneus, which is a type of fracture that involves the growth plate (physeal) and extends through the metaphysis and epiphysis of the bone. Understanding alternative names and related terms can be beneficial for medical professionals, coders, and researchers. Here’s a detailed overview:

Alternative Names

1. Salter-Harris Type IV Fracture: This is the primary alternative name, emphasizing the classification of the fracture based on the Salter-Harris system, which categorizes growth plate injuries.

2. Calcaneal Physeal Fracture: This term highlights the location of the fracture (calcaneus) and its involvement with the growth plate.

3. Intra-articular Calcaneal Fracture: Since Salter-Harris Type IV fractures extend into the joint surface, this term may also be used to describe the fracture's nature.

4. Epiphyseal Fracture of the Calcaneus: This term focuses on the involvement of the epiphysis in the fracture.

Related Terms

1. Growth Plate Fracture: A general term that encompasses all types of fractures involving the growth plate, including Salter-Harris types.

2. Pediatric Fracture: Since Salter-Harris fractures are more common in children due to their developing bones, this term is often associated with such injuries.

3. Traumatic Fracture: This term refers to fractures caused by trauma, which is the typical cause of Salter-Harris fractures.

4. Foot Fracture: A broader category that includes fractures of the calcaneus as well as other bones in the foot.

5. Salter-Harris Classification: This is the system used to classify physeal fractures, which includes five types, with Type IV being one of them.

6. Calcaneal Fracture: A general term for any fracture of the calcaneus, which may include various types beyond just Salter-Harris classifications.

Conclusion

Understanding the alternative names and related terms for ICD-10 code S99.04 is crucial for accurate diagnosis, coding, and communication among healthcare professionals. These terms not only facilitate better understanding of the specific injury but also enhance clarity in medical documentation and billing processes. If you need further information on coding or classification systems, feel free to ask!

The diagnosis of an ICD-10 code, specifically S99.04 for a Salter-Harris Type IV physeal fracture of the calcaneus, involves several criteria that healthcare professionals must consider. Understanding these criteria is essential for accurate coding and effective treatment planning.

Overview of Salter-Harris Fractures

Salter-Harris fractures are classified based on their involvement with 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, with Type IV being particularly significant as it involves both the metaphysis and epiphysis, potentially impacting the growth plate.

Diagnostic Criteria for S99.04

1. Clinical Presentation:
   - Symptoms: Patients typically present with localized pain, swelling, and tenderness around the heel. There may also be difficulty bearing weight on the affected foot.
   - Physical Examination: A thorough examination may reveal deformity, bruising, or an inability to move the ankle or foot.

2. Imaging Studies:
   - X-rays: The primary diagnostic tool for identifying a Salter-Harris Type IV fracture is an X-ray. The fracture line must traverse the growth plate, extending through the metaphysis and epiphysis of the calcaneus.
   - CT or MRI: In some cases, advanced imaging techniques like CT scans or MRIs may be utilized to assess the fracture's extent and to evaluate any associated soft tissue injuries.

3. Mechanism of Injury:
   - Trauma History: A detailed history of the injury is crucial. Salter-Harris Type IV fractures often result from high-energy trauma, such as falls from a height or sports-related injuries.

4. Age Consideration:
   - Patient Demographics: These fractures are most commonly seen in pediatric patients, as the growth plates are still open. The age of the patient is a critical factor in diagnosing and coding this type of fracture.

5. Exclusion of Other Conditions:
   - Differential Diagnosis: It is important to rule out other potential injuries, such as simple fractures or soft tissue injuries, that may present similarly. This may involve additional imaging or clinical assessments.

Coding Specifics

When coding for a Salter-Harris Type IV physeal fracture of the calcaneus, the specific ICD-10 code S99.04 is used. This code is part of a broader category that includes various types of physeal fractures. Accurate coding is essential for proper documentation, billing, and treatment planning.

Conclusion

In summary, the diagnosis of a Salter-Harris Type IV physeal fracture of the calcaneus (ICD-10 code S99.04) requires a combination of clinical evaluation, imaging studies, and consideration of the patient's age and injury mechanism. Proper identification and coding of this fracture type are crucial for ensuring appropriate management and follow-up care, as these injuries can have significant implications for a child's growth and development.

Salter-Harris Type IV physeal fractures, particularly those affecting the calcaneus (heel bone), are significant injuries that can impact growth and development in children and adolescents. Understanding the standard treatment approaches for this type of fracture is crucial for optimal recovery and minimizing long-term complications.

Overview of Salter-Harris Type IV Fractures

Salter-Harris fractures are classified based on their involvement with the growth plate (physeal plate). Type IV fractures extend through the metaphysis, physis, and epiphysis, which can disrupt normal growth and lead to complications such as limb length discrepancies or angular deformities if not treated appropriately[5][7]. The calcaneus is particularly vulnerable due to its weight-bearing role and the forces exerted during activities.

Initial Assessment and Diagnosis

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

• Clinical Evaluation: Assessing the patient's history, mechanism of injury, and physical examination to identify swelling, tenderness, and range of motion limitations.
• Imaging Studies: X-rays are the primary imaging modality used to confirm the diagnosis and assess the fracture's alignment and displacement. In some cases, CT scans may be utilized for a more detailed view of complex fractures[6][9].

Standard Treatment Approaches

1. Non-Surgical Management

In cases where the fracture is non-displaced or minimally displaced, conservative treatment may be sufficient:

• Immobilization: The affected foot is typically immobilized using a cast or a walking boot to allow for healing. The duration of immobilization can vary but generally lasts 4 to 6 weeks.
• Weight Bearing: Initially, weight-bearing is restricted. Gradual reintroduction of weight-bearing activities is encouraged as healing progresses, often guided by follow-up imaging to ensure proper alignment[4][6].

2. Surgical Intervention

Surgical treatment is often indicated for displaced fractures or when there is a risk of growth plate involvement leading to complications:

• Open Reduction and Internal Fixation (ORIF): This procedure involves surgically realigning the fracture fragments and stabilizing them with plates and screws. ORIF is typically performed to restore the anatomy of the calcaneus and ensure proper healing.
• Postoperative Care: After surgery, the patient will require a period of immobilization, followed by physical therapy to regain strength and range of motion. Regular follow-up appointments are essential to monitor healing and adjust rehabilitation protocols as needed[3][7].

3. Rehabilitation

Rehabilitation plays a critical role in recovery:

• Physical Therapy: Once the fracture has healed sufficiently, physical therapy focuses on restoring function, strength, and flexibility. This may include exercises to improve range of motion and strength in the ankle and foot.
• Gradual Return to Activity: Patients are typically guided through a gradual return to normal activities, including sports, to prevent re-injury and ensure full recovery[10][11].

Conclusion

The management of Salter-Harris Type IV physeal fractures of the calcaneus requires a careful balance between ensuring proper healing and minimizing the risk of complications. Both non-surgical and surgical approaches have their place, depending on the fracture's characteristics and the patient's overall health. Close monitoring and rehabilitation are essential components of the treatment plan to facilitate a successful recovery and return to normal activities. Regular follow-ups with healthcare providers will help ensure that any potential complications are addressed promptly, promoting optimal long-term outcomes.