![]() ![]() ![]() Thorough evaluation and documentation of the local soft-tissue condition is critical. 7Ĭlinical examination of the patient with a distal tibial fracture should be performed according to the Advanced Trauma Life Support protocol, 14 as a significant number of patients may have additional injuries.Ĭlinical examination includes a thorough, systematic clinical assessment to include peripheral pulses and a careful neurological assessment. If the ankle is in a neutral position, usually total involvement of the articular surface is seen with a Y-type separation of anterior and posterior fragments frequently with central joint impaction ( Fig. The opposite situation occurs when the foot is dorsiflexed causing the talar dome to impact on the anterior part of the distal tibial articular surface. With plantarflexion of the foot, most forces are directed to the dorsal (posterior) part of the articular surface and lead to the formation of a relatively large posterior fragment. The severity of the articular injury depends on the amount of energy applied and the position of foot at the time of impact. On the other hand, higher energy axial compression forces lead to intra-articular fractures of the distal tibia when the convex talar dome impacts the concave plafond of the distal tibia. These are usually closed, resulting from low energy and the associated soft-tissue injuries are not usually severe. ![]() Rotational forces (torsion) usually lead to a spiral fracture which may be intra- or extra-articular. All rights reserved.Mechanisms of injury, epidemiology and concomitant injuriesĭistal tibial fractures are usually caused by two possible types of forces: rotational and/or axial loads. 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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