A fracture is a break in a bone resulting from two possible causes: the direct or indirect application of undue force against the bone and pathological changes resulting in spontaneous fractures. This chapter includes only those fractures that have arisen as a result of an injury. It includes delayed healing and nonunions of fractured bones. In the case of a fracture, the type of fracture (e.g., displaced or nondisplaced, open or closed) and the episode of care are components of the code.
Closed fractures are contained beneath the skin, while open or compound fractures connote an associated open wound. Open fractures are always compound, with a wound leading to the fracture or the broken bone ends protruding through the skin. There is a high risk of infection with open fractures since the tissues are exposed to contaminants.
Specific terminology is used to describe fractures that pertain to bones in a particular part of the body. Those terms are defined in their respective subcategories. The following fracture types and definitions are used across many areas of the body, especially the extremities:
- Comminuted: Bone is fractured, splintered, or shattered into multiple pieces, contains small bone fragments, usually caused by severe force
- Greenstick: Incomplete fracture, bone bends and cracks, common in young, flexible bones of children
- Oblique: Fracture at a diagonal angle across the bone shaft
- Physeal: Pediatric fractures of the growth plate or physis. Salter-Harris classification system is a method of describing the involvement of the physis, metaphysis, and epiphysis of the fracture
- Segmental: Bone is broken in two places leaving at least one segment unattached to the body of bone
- Spiral: Also called a torsion fracture, caused by a twisting force resulting in a diagonal fracture around and through the bone
- Transverse: Fracture straight across the bone at a right angle to the long axis of the bone
The codes for fractures capture the type of encounter and whether the fracture is open or closed; open fractures are broken down further by the type of fracture based on the Gustilo classification. The Gustilo classification describes the severity of open fracture and soft tissue injury. Following are the definitions for open fractures as defined by the Gustilo classification:
- Type I: Low energy injury, clean wound less than 1 cm
- Type II: Wound is more than 1 cm with moderate soft tissue damage
- Type III: High energy wound, greater than 1 cm with extensive soft tissue damage, and subclassified to IIIA, IIIB, and IIIC
- Type IIIA: Adequate soft tissue coverage despite extensive soft tissue damage
- Type IIIB: Inadequate soft tissue coverage usually with severe wound contamination
- Type IIIC: Type III open fracture associated with arterial injury
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