2016 2017 2018 2019 Billable/Specific Code. S42.291A is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Short description: Oth disp fx of upper end of right humerus, init for clos fx. The 2018/2019 edition of ICD-10-CM S42.291A became effective on October 1, 2018.
The four parts are the humeral head, the greater tuberosity, the lesser tuberosity and the humeral shaft. Displacement is on a per-part basis. A fracture part is considered displaced if angulation exceeds 45 degrees, or if the fracture is displaced by more than 1 cm 1.
The terminology and factors which influence the classification are essential for the utility of radiological reports of proximal humeral fractures. The two main components of the classification are the number of fracture parts and the displacement 1,4-6.
The proximal humerus can be considered to consist of the humeral head, the tuberosities, and the humeral shaft ( Fig. 5-1 ). tuberosities. The surgical neck lies between the tuberosities and the
Fractures of the proximal humerus are common and account for 4 to 5% of all fractures. 1 – 3 Court-Brown et al 4 prospectively studied the incidence of all classes of proximal humerus fractures over a 5-year period. Proximal humerus fractures occurred predominantly in elderly females; 73% of patients were female, with an average age of 70 years, and the remaining males had an average age of 56 years. The predominant mechanism of injury was a fall from a standing height in 87% of patients. Shoulder fractures that arise from sports injuries and higher energy trauma tended to occur in younger male patients in their third to fifth decades.
One-part fractures may have one or many fracture lines, but radiographs do not show significant displacement or angulation of fragments. Two-part fractures most commonly involve fracture of the surgical neck with angulation or fracture of the greater tuberosity with displacement. Three-part fractures have a displaced and angulated humeral shaft in ...
4 Early range of motion is essential in optimizing outcome, and Koval et al 7, 10 recommended that motion exercise be initiated no later than 14 days.
A careful neurovascular examination is mandatory to identify any associated neurovascular injuries. The axillary nerve is the most common nerve injured and should be carefully tested with sensation over the deltoid. Deltoid muscle testing is usually compromised secondary to pain. The remainder of the peripheral nerves must also be assessed. Alteration in peripheral pulses suggests injury to the axillary artery, which can occur with fracture-dislocations and can be limb threatening. Echymosis and edema can be significant, and fracture blisters are common in the elderly because of fragile skin.
Two-part lesser tuberosity fractures are uncommon, and the diagnosis is often missed . This fracture pattern may occur in combination with a posterior glenohumeral dislocation, and adequate imaging is required to ensure the glenohumeral joint is reduced. Often CT scanning is required to determine displacement and the extent of humeral head articular involvement that may be attached to the lesser tuberosity. 17
The four parts are the humeral head, the greater tuberosity, the lesser tuberosity and the humeral shaft. Displacement is on a per-part basis.
The Neer classification of proximal humeral fractures is probably the most frequently used system along with the AO classification of proximal humeral fractures. The terminology and factors which influence the classification are essential for the utility of radiological reports of proximal humeral fractures.