Fractures 1

(Version: 04/16/04)

Definition: Fractures of the skeletal system.

Introduction: Select the fracture disorder concept that most closely describes the affected bone, fracture site and whether the fracture is open or closed.

• Open fracture of Femur (Disorder) (28576007)

If a pre-coordinated disorder concept for the specific affected bone site does not exist, add the appropriate finding site, for example:

• Open fracture of Femur (Disorder) (28576007)
• Finding site ‘attribute’ ( 363698007)
• Bone structure of shaft of femur (Body structure) (41111004)

If a pre-coordinated disorder concept for the fracture morphology does not exist, or if additional morphologies are necessary, add as follows:

• Open fracture of Femur (Disorder) (28576007)
• Associated morphology ‘attribute’(116676008)
• Greenstick fracture (Morphology) (30543000)*

* Note:

Do not add redundancy. For example, adding the morphology ‘Open greenstick fracture’ would be a redundancy as ‘open’ is already part of the disorder concept.

Also, when the appropriate disorder concept ‘Open or Closed Fracture’ does not exist, it may be necessary to use the disorder concept “Fracture of ‘specific bone’” and add the ‘open or closed’ specific fracture morphology. This is a common practice for veterinary specific sites.

Laterality (right, left, or bilateral) may be added to further define the concept:

• Open fracture of Femur (Disorder) (28576007)
• With laterality ‘attribute’ ( 7861500)
• Right (Qualifier value) (24028007)

Note : You can only lateralize a bone you have more than one of symmetrically, e.g. Fracture right skull cannot be lateralized. You would need to add a finding site of right side of head.

Root Concept (Disorders):

• Fracture of Bone (Disorder) (125605004)

Comments:

1. Compression fractures (disorders) are inconsistently modeled. Not all contain the morphology ‘compression fracture’ within their definition. For those that do not, the morphology needs to be added to complete the concept. (See example 1 below)
2. Avoid using pre-coordinated concepts with multiple fracture topographies as it is difficult to further define a specific fracture site with a specific fracture morphology, e.g. spiral fracture of tibia and comminuted fracture of fibula (See example 2 below)
3. Attempt to use codes without ‘human orientation’. Instead of finger, toe, hand, foot, etc., use for example, Fracture of phalanx and add a finding site. Be creative when searching for veterinary topographies (equine sites are often listed under common or lay terms, e.g. pastern/coffin bones. and bovine topographies are listed as abbreviations, e.g. P1, P2, etc. However, it is sometimes necessary to use comparable human terminology as these are the only options, e.g. tarsal bones = ankle and carpal bone = wrist. One can always go up the tree to Fracture of upper or lower limb and add a finding site.

Examples:

Case 1: "Compression fracture sacral, open"

Open Compression Fracture Sacrum (disorder) 207978006

• Associated morphology 116676008
• Compression fracture (morphology) 21947006

 

 

Case 2: "Tibia spiral fracture with comminuted fracture of fibula"

Fracture of tibia (disorder) 31978002

• Associated morphology 116676008
• Spiral fracture (morphologic abnormality) 73737008

Fracture of fibula (disorder) 75591007

• Associated morphology 116676008
• Comminuted fracture (morphologic abnormality) 13321001

1Written by the VMDB Taskforce on Development of SNOMED Guidelines. The committee wishes to recognize contributions provided by Dr. Jeff Wilcke and Dr. Penny Livesay.