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Pediatric Proximal Tibial Fracture S82.109A 823.00

 

synonyms: Proximal Metaphyseal fracture, Cozen's Fracture

Pediatric Proximal Tibial Fracture ICD-10

 

A- initial encounter for closed fracture

B- initial encounter for open fracture

C- initial encounter for open fracture type IIIA, IIIB, or IIIC

D- subsequent encounter for fracture with routine healing

E- subsequent encounter for open fracture type I or II with routine healing

F- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

G- subsequent encounter for fracture with delayed healing

H- subsequent encounter for open fracture type I or II with delayed healing

J- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

K- subsequent encounter for fracture with nonunion

M- subsequent encounter for open fracture type I or II with nonunion

N- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

P- subsequent encounter for fracture with malunion

Q- subsequent encounter for open fracture type I or II with malunion

R- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

S- sequela

Pediatric Proximal Tibial Fracture ICD-9

  • 823.4(Torus fracture), 823.00(upper end, closed), 823.20(upper end open), 823.02(upper end with fibula fx, closed), 823.22(upper end with fibular fx, open), 823.20(shaft closed), 823.22(shaft closed with fibula fx), 823.30(shaft, open)
  • usually children age 6 years or younger
  • associated with tibial overgrowth and a progressive valgus deformity can develop.

Pediatric Proximal Tibial Fracture Etiology / Epidemiology / Natural History

  • Common in children 2-6 years old.
  • Generally fall from height or direct blow.

Pediatric Proximal Tibial Fracture Anatomy

Pediatric Proximal Tibial Fracture Clinical Evaluation

    • Leg pain, inability to bear weight, contusions, deformity
    • Evaluate extent of soft tissues, open fracture injury
    • Document neurovascular exam before and after any treatment
    • Evaluate for Compartment Syndrome.

Pediatric Proximal Tibial Fracture Xray / Diagnositc Tests

  • A/P and Lateral of tibia, must include ankle and knee
  • CT if intraarticular extention is a concern.

Pediatric Proximal Tibial Fracture Classification / Treatment

  • Transverse impaction fracture, greenstick fracture in patient <6years old
    -Treatment: To minimize the development of valgus deformity, any acute valgus fracture deformity must be reduced or overreduced with the extremity immobilized in a long-leg cast in extension. Discuss unpredictable tendency for valgus deformity with parents.
  • High Energy fracture in patient >6years old
    -Treatment: dependent on soft tissue injury and fracture displacement. Options: cast, Ex Fix, ORIF.
  • Valgus Deformity: always discuss with parents before treatment. Occurs in 50% of proximal metaphyseal fractures. Maximal deformity occurs at 18 months postinjury followed by gradually remodelling over several years. (Robert M, JPO 1987;7:444).
  • Valgus deformity noted after fracture healing should be observed. Initial progression of deformity is typically followed by subsequent remodeling for mild to moderate deformities.
  • Correction by osteotomy or staple should be deferred as long as possible so as to minimize the potential for recurrence. Correction of a recurrence, if necessary, can be obtained with staple hemiepiphysiodesis. (McCarthy JJ, JPO 1998;18:518).

Pediatric Proximal Tibial Fracture Associated Injuries / Differential Diagnosis

  • Pediatric tibial shaft fracture
  • Vascular injury: popliteal artery is tethered by the major branches near the posterior aspect of the proximal tibial epiphysis.

Pediatric Proximal Tibial Fracture Complications

  • Valgus defomity

Pediatric Proximal Tibial Fracture Follow-up Care

  • Typically heals in 3 weeks.
  • 6-12 month follow-ups to ensure valgus deformity does not develop.

Pediatric Proximal Tibial Fracture Review References