ICD-10: M84.75

Atypical femoral fractures, classified under ICD-10 code M84.75, are a specific type of nontraumatic fracture that typically occurs in the femur, particularly in the subtrochanteric region or the diaphysis. These fractures are characterized by their unique presentation and are often associated with certain risk factors, particularly the long-term use of bisphosphonates, which are medications commonly prescribed for osteoporosis.

Clinical Description

Definition

Atypical femoral fractures are defined as complete or incomplete fractures of the femur that occur with minimal or no trauma. They are distinct from typical femoral fractures, which usually result from significant trauma or injury. The atypical fractures often present with specific radiographic features, including:

• Location: Typically occurring in the subtrochanteric region or the femoral shaft.
• Fracture Pattern: These fractures may be transverse or oblique and often have a characteristic "beaking" or cortical thickening at the fracture site.
• Bilateral Occurrence: Atypical femoral fractures can occur bilaterally, meaning they may affect both legs simultaneously.

Symptoms

Patients with atypical femoral fractures may experience:

• Pain: Often localized to the thigh or groin, which may precede the fracture.
• Swelling and Bruising: May occur around the fracture site.
• Inability to Bear Weight: Patients may find it difficult or impossible to walk or bear weight on the affected leg.

Risk Factors

Several factors contribute to the risk of developing atypical femoral fractures:

• Long-term Bisphosphonate Use: Patients on bisphosphonates for osteoporosis treatment are at increased risk, particularly after extended use (typically more than five years) [1].
• Low Bone Mineral Density: Individuals with osteoporosis or low bone density are more susceptible to fractures.
• Previous Fractures: A history of prior fractures can indicate a higher risk for atypical fractures.
• Certain Medical Conditions: Conditions such as rheumatoid arthritis or other metabolic bone diseases may also increase risk.

Diagnosis

Diagnosis of atypical femoral fractures typically involves:

• Clinical Evaluation: A thorough history and physical examination to assess symptoms and risk factors.
• Imaging Studies: X-rays are the primary imaging modality used to confirm the presence and type of fracture. In some cases, MRI may be utilized to evaluate stress fractures that are not yet visible on X-rays.

Treatment

Management of atypical femoral fractures generally includes:

• Surgical Intervention: Many cases require surgical fixation to stabilize the fracture, especially if it is complete.
• Modification of Osteoporosis Treatment: Patients may need to reassess their osteoporosis management, particularly regarding bisphosphonate therapy.
• Rehabilitation: Physical therapy is often necessary to restore function and strength post-fracture.

Conclusion

ICD-10 code M84.75 encompasses atypical femoral fractures, which are significant due to their association with specific risk factors and their unique clinical presentation. Understanding the characteristics, risk factors, and management strategies for these fractures is crucial for healthcare providers to ensure appropriate diagnosis and treatment. Regular monitoring and patient education regarding the risks associated with long-term bisphosphonate use are essential in preventing these fractures.

For further details on coding and clinical guidelines, healthcare professionals can refer to the latest ICD-10-CM updates and coding resources [2][3].

Atypical femoral fractures, classified under ICD-10 code M84.75, are a specific type of fracture that typically occurs in the femur, particularly in the subtrochanteric region. These fractures are often associated with certain risk factors and clinical presentations that are important for diagnosis and management. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with atypical femoral fractures.

Clinical Presentation

Atypical femoral fractures are characterized by specific features that differentiate them from typical femoral fractures. They often occur with minimal or no trauma, which is a key indicator of their atypical nature. The fractures are usually located in the subtrochanteric region or the femoral shaft and can be bilateral, meaning they may occur in both legs simultaneously.

Signs and Symptoms

1. Pain: Patients typically present with localized pain in the thigh or groin area. This pain may be gradual in onset and can worsen with activity or weight-bearing.

2. Swelling and Bruising: There may be visible swelling or bruising around the fracture site, although this is not always present.

3. Decreased Mobility: Patients often experience a significant reduction in mobility due to pain and instability. They may have difficulty walking or standing.

4. Mechanical Symptoms: Some patients report a sensation of instability or a feeling that the leg may give way, particularly during weight-bearing activities.

5. Pre-existing Conditions: Many patients have a history of conditions that predispose them to atypical fractures, such as osteoporosis or long-term use of bisphosphonates, which are medications commonly prescribed for osteoporosis management.

Patient Characteristics

Atypical femoral fractures are more commonly observed in specific patient populations:

1. Age: These fractures predominantly occur in older adults, particularly postmenopausal women, due to the higher prevalence of osteoporosis in this demographic.

2. Gender: Women are more frequently affected than men, largely due to hormonal changes associated with menopause that contribute to bone density loss.

3. Medication History: A significant number of patients with atypical femoral fractures have a history of long-term bisphosphonate therapy. Studies have indicated that prolonged use of these medications can lead to changes in bone remodeling, increasing the risk of atypical fractures[1][2].

4. Bone Health: Patients often have underlying conditions that affect bone health, such as osteoporosis or other metabolic bone diseases. A history of previous fractures may also be present, indicating a higher risk profile.

5. Lifestyle Factors: Sedentary lifestyle, low physical activity levels, and nutritional deficiencies (such as vitamin D deficiency) can further contribute to the risk of developing atypical femoral fractures.

Conclusion

Atypical femoral fractures, represented by ICD-10 code M84.75, present with distinct clinical features and are associated with specific patient characteristics. Recognizing the signs and symptoms, along with understanding the risk factors, is crucial for timely diagnosis and management. Clinicians should maintain a high index of suspicion for atypical fractures in patients with relevant histories, particularly those on long-term bisphosphonate therapy or with known osteoporosis. Early intervention can help mitigate complications and improve patient outcomes[3][4].

For further management, a multidisciplinary approach involving orthopedic specialists, endocrinologists, and rehabilitation professionals may be beneficial to address both the fracture and the underlying bone health issues.

Atypical femoral fractures, classified under the ICD-10 code M84.75, are a specific type of nontraumatic fracture that can occur in the femur, particularly in patients who are on long-term bisphosphonate therapy or have certain metabolic bone diseases. Understanding the alternative names and related terms for this condition can enhance clarity in medical documentation and communication.

Alternative Names for Atypical Femoral Fracture

1. Atypical Femur Fracture: This term is often used interchangeably with atypical femoral fracture and refers to fractures that occur in the femur without a significant traumatic event.

2. Non-Traumatic Femoral Fracture: This broader term encompasses fractures that occur without trauma, including atypical fractures.

3. Subtrochanteric Fracture: A specific type of atypical femoral fracture that occurs just below the trochanteric region of the femur.

4. Diaphyseal Femoral Fracture: Refers to fractures occurring in the diaphysis (the shaft) of the femur, which can include atypical fractures.

5. Stress Fracture of the Femur: While not identical, stress fractures can be related to the same underlying conditions that predispose individuals to atypical femoral fractures.

Related Terms

1. Osteoporosis: A condition that weakens bones, making them more susceptible to fractures, including atypical femoral fractures.

2. Bisphosphonate-Related Fractures: Refers to fractures that may occur in patients taking bisphosphonates, a class of drugs used to treat osteoporosis, which can lead to atypical femoral fractures.

3. Incomplete Atypical Femoral Fracture: This term, represented by the ICD-10 code M84.752, refers to a type of atypical fracture that does not extend completely through the bone.

4. Complete Atypical Femoral Fracture: This term describes a fully developed atypical fracture, which is often more severe and may require surgical intervention.

5. Low-Energy Fracture: A term that describes fractures occurring from minimal trauma, which is characteristic of atypical femoral fractures.

6. Pathologic Fracture: A fracture that occurs in a bone weakened by disease, which can include atypical femoral fractures.

Understanding these alternative names and related terms is crucial for healthcare professionals when diagnosing, coding, and discussing atypical femoral fractures. Proper terminology ensures accurate communication and documentation, which is essential for effective patient care and treatment planning.

Atypical femoral fractures, classified under ICD-10 code M84.75, are a specific type of nontraumatic fracture that typically occurs in the femur, particularly in the subtrochanteric region. The diagnosis of atypical femoral fractures involves several criteria, which are essential for accurate identification and coding. Below are the key diagnostic criteria and considerations:

Diagnostic Criteria for Atypical Femoral Fractures

1. Clinical Presentation

• Location of Fracture: Atypical femoral fractures usually occur in the subtrochanteric region or the femoral shaft. The fracture may be transverse or short oblique and can be associated with minimal or no trauma.
• Symptoms: Patients may present with thigh or groin pain, which can precede the fracture by weeks or months. This pain is often localized and may worsen with activity.

2. Radiographic Findings

• X-ray Characteristics: Radiological evaluation is crucial. Atypical fractures typically show:
  • A transverse or short oblique fracture line.
  • A medial spike or cortical thickening at the fracture site.
  • Minimal comminution (fragmentation) of the bone.
• Bilateral Fractures: It is also important to assess for bilateral involvement, as atypical fractures can occur in both femurs, often simultaneously or sequentially.

3. Risk Factors

• Medication History: A significant association exists between atypical femoral fractures and the use of bisphosphonates or other anti-osteoporotic medications. A history of prolonged use (typically more than five years) is a notable risk factor.
• Bone Density: Patients may have underlying osteoporosis or low bone density, which can contribute to fracture risk.

4. Exclusion of Other Causes

• Trauma Assessment: The fracture should not be attributed to significant trauma, such as a fall from standing height or higher. Atypical fractures are characterized by their occurrence with minimal or no trauma.
• Differential Diagnosis: Other conditions that may cause similar symptoms or radiographic findings should be ruled out, including metastatic disease or other pathological fractures.

5. ICD-10 Coding Specifics

• Code M84.75: This code specifically refers to atypical femoral fractures. It is important to document the fracture's characteristics and any relevant patient history to support the diagnosis and coding accurately.

Conclusion

The diagnosis of atypical femoral fractures under ICD-10 code M84.75 requires a comprehensive approach that includes clinical evaluation, radiographic assessment, and consideration of risk factors. Proper identification is crucial for appropriate management and treatment, particularly in patients with a history of bisphosphonate use or other risk factors for osteoporosis. Accurate coding not only aids in patient care but also ensures proper documentation for healthcare billing and statistical purposes.

Atypical femoral fractures, classified under ICD-10 code M84.75, are a specific type of fracture that typically occurs in the subtrochanteric region of the femur. These fractures are often associated with long-term use of bisphosphonates, medications commonly prescribed for osteoporosis. Understanding the standard treatment approaches for these fractures is crucial for effective management and recovery.

Overview of Atypical Femoral Fractures

Atypical femoral fractures are characterized by specific features, including:

• Location: They usually occur in the subtrochanteric region or the femoral shaft.
• Mechanism: Often, these fractures occur with minimal or no trauma, which distinguishes them from typical femoral fractures.
• Patient Profile: They are more frequently seen in patients who have been on bisphosphonate therapy for an extended period, particularly those with osteoporosis[1][2].

Standard Treatment Approaches

1. Surgical Intervention

Surgical treatment is often necessary for atypical femoral fractures due to their location and the need for stabilization. The primary surgical options include:

• Intramedullary Nailing: This is the most common surgical procedure for atypical femoral fractures. It involves inserting a metal rod into the femur to stabilize the fracture. Studies have shown that intramedullary nailing can lead to good healing outcomes, although there may be a high revision rate in some cases[3][4].

• Plate Fixation: In certain cases, especially when the fracture is more complex, plate fixation may be used. This involves attaching a metal plate to the outside of the femur to hold the bone fragments together.

2. Conservative Management

In cases where the fracture is non-displaced or stable, conservative management may be considered. This includes:

• Weight Bearing Restrictions: Patients may be advised to limit weight-bearing activities to allow for healing.

• Physical Therapy: Once the initial healing has occurred, physical therapy can help restore strength and mobility.

3. Medication Management

Given the association between atypical femoral fractures and bisphosphonate use, it is essential to evaluate the patient's medication regimen:

• Review of Bisphosphonate Therapy: If a patient presents with an atypical femoral fracture, a thorough review of their bisphosphonate therapy is warranted. In some cases, discontinuation or modification of the treatment may be necessary to prevent further complications[5].

• Calcium and Vitamin D Supplementation: Ensuring adequate calcium and vitamin D intake is crucial for bone health, especially in patients with osteoporosis.

4. Monitoring and Follow-Up

Regular follow-up appointments are essential to monitor the healing process and assess for any complications. This may include:

• Radiographic Evaluation: X-rays or other imaging studies may be performed to ensure proper alignment and healing of the fracture.

• Assessment for Other Risk Factors: Evaluating the patient for other risk factors for fractures, such as vitamin D deficiency or other medications that may affect bone health, is important.

Conclusion

The management of atypical femoral fractures (ICD-10 code M84.75) typically involves a combination of surgical intervention, conservative management, and careful medication review. Intramedullary nailing is the preferred surgical approach, while conservative measures may be appropriate for stable fractures. Ongoing monitoring and adjustments to osteoporosis treatment are critical to prevent future fractures and ensure optimal recovery. As always, treatment should be tailored to the individual patient's needs and circumstances, with a multidisciplinary approach when necessary.