Look in your code book under the main category for the fracture you are code. In general the 7th character for fractures are:
A Initial encounter for closed fracture
B Initial encounter for open fracture type I, or II
C Initial encounter for open fracture type IIIA, IIIB, IIIC
D Subsequent encounter for closed fracture with routine healing
E Subsequent encounter for open fracture type I or II with routine healing
F Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
G Subsequent encounter for closed fracture with delayed healing
H Subsequent encounter for open fracture type I or II with delayed healing
J Subsequent encounter for open fracture Type IIIA, IIIB, or IIIC with delayed healing
K Subsequent encounter for closed fracture with nonunion
M Subsequent encounter for open fracture type I or II with nonunion
N Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
P Subsequent encounter for closed fracture with malunion
Q Subsequent encounter for open fracture type I or II with malunion
R Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion
S Sequelae