The fibular fracture may be found 1-2cm (0.5-1 inch) above the ankle joint level, or anywhere higher, including all of the way up to just below the knee. Typically, when the fibular (bone on the outside of the ankle) fracture occurs above the ankle joint level, there is an associated syndesmosis injury. Since ligaments (and the syndesmosis) cannot be directly visualized on radiographs (plain x-ray films), it is fortunate that we can reliably predict when there has been a syndesmosis injury in conjunction with the fracture(s). Thus, in an ankle fracture with an unstable syndesmosis, surgery is typically recommended. ![]() Because of a disrupted, unstable syndesmosis, the tibia and fibula are not held together properly, which makes for a very unstable ankle joint that is prone to chronic disability and arthritis – if not repaired. In some fractures, the ligament structures (called the syndesmosis) that hold together the two leg bones (the tibia and the fibula) that form the ankle socket are torn. Perhaps the most important “classification” of ankle fracture to both the doctor and the patient is whether the fracture will need surgical correction or not. Ankle fractures can be classified by the mechanism that caused that fracture, or the number of locations that have fractured, or by the location of the fracture of the fibula (the bone on the outside of the ankle) relative to the ankle joint line. There are many varieties of ankle fracture that can occur. Tips and Instructions from the Cast Room.Ankle Fracture with Unstable Syndesmosis.Patients with Sensation or Circulation Loss in the Feet.Midfoot Impingement Syndrome and Degenerative Joint Disease of the Midfoot.Excess Body Weight and Foot and Ankle Problems.Database research that relies on ICD-10 coding as a surrogate for primary clinical data should be interpreted with caution and institutions should make efforts to increase the accuracy of their coding.Īccuracy Ankle fracture ICD-10 coding Positive predictive value.Ĭopyright © 2021 Elsevier Ltd. There is substantial discordance between existing EMR and surgeon-assigned ICD-10 codes for ankle fractures. EMR codes were specific but not sensitive. Generalized "other fracture" codes comprised 45% of EMR codes compared to only 6% of assigned codes (p < 0.001). Lateral malleolus fracture codes demonstrated the highest PPV (0.91, 95% CI 0.72-0.99), while the lowest PPV was found for "other fractures of the lower leg" (0.05, 95% CI 0.0-0.24) and "other fracture of the fibula" (0.0, 95% CI 0.0-0.15). Aggregate agreement between all codes was fair (K = 0.26). ![]() Agreement between the correct code and the electronic medical record (EMR) assigned code was determined using kappa's statistic in the aggregate as well as percent agreement, sensitivity, specificity, and positive predictive value (PPV) between individual codes.ĥ9 of 97 cases (60.8%) demonstrated discordance between the existing EMR and surgeon-assigned codes. Injury radiographs were reviewed by three authors to determine the correct code. Retrospective cohort study PATIENTS: 97 adult patients with fractures about the ankle (rotational ankle fracture or distal tibia fracture) from 2016 to 2020, selected by stratified random sampling.Īssignment of an ICD-10 code representative of a rotational ankle fracture, pilon fracture, or unspecified fracture of the lower leg. To determine the accuracy of International Classification of Disease Version 10 (ICD-10) coding for ankle fracture injury patterns.
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