ICD-10 Code for Distal Radius Fracture Through Growth Plate with Ulnar Styloid Fracture
The appropriate ICD-10 code for a distal radius fracture through the growth plate with 1.2cm dorsal displacement of epiphysis with respect to metaphysis and an accompanying ulnar styloid fracture is S59.101A (Salter-Harris Type I physeal fracture of lower end of radius, right arm, initial encounter) with an additional code S59.001A for the ulnar styloid fracture. 1
Fracture Classification and Coding Details
- This injury represents a physeal (growth plate) fracture of the distal radius with significant displacement (1.2cm) and an associated ulnar styloid fracture 1
- According to the Salter-Harris classification system, this would be classified as a Type I or II fracture, depending on whether the fracture line extends into the metaphysis 1
- The 1.2cm dorsal displacement indicates significant displacement requiring careful management, as displacement >3mm is generally considered significant 2
- The ulnar styloid fracture should be coded separately as it represents a distinct injury pattern commonly associated with distal radius fractures 3, 4
Clinical Implications of This Fracture Pattern
- Distal radius fractures through the growth plate require careful management to prevent growth disturbances, which occur in approximately 4.4% of distal radial physeal injuries 1
- The significant displacement (1.2cm) indicates potential instability and may require surgical intervention rather than conservative management 5, 2
- Radiographic evaluation with at least 3 views (posteroanterior, lateral, and 45° semipronated oblique) is standard for distal radius fractures 5
- CT imaging may be warranted for better evaluation of the fracture pattern and displacement, particularly with intra-articular involvement 5
Management Considerations
- Operative fixation is typically indicated for physeal fractures with >2mm of articular step-off to avoid long-term complications such as osteoarthritis 5
- The 1.2cm dorsal displacement exceeds standard thresholds for conservative management and likely requires surgical intervention 2
- The associated ulnar styloid fracture may not require separate fixation, as studies have shown no significant difference in outcomes between treatment and non-treatment of ulnar styloid fractures when the radius fracture is properly managed 5, 3
- Approximately 32% of distal radius fractures with ulnar styloid fractures have associated triangular fibrocartilage complex (TFCC) tears, which may affect stability of the distal radioulnar joint 6
Follow-up Considerations
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 7
- Long-term monitoring for growth disturbances is essential, particularly for physeal injuries with significant displacement 1
- Active finger motion exercises should be performed following treatment to prevent stiffness, which is one of the most functionally disabling adverse effects of distal radius fractures 7, 2