ICD-10: M91.1

Juvenile osteochondrosis of the head of the femur, commonly known as Legg-Calvé-Perthes disease, is a significant pediatric orthopedic condition characterized by the avascular necrosis of the femoral head. This condition primarily affects children, typically between the ages of 4 and 10, and is more prevalent in boys than girls.

Clinical Description

Pathophysiology

Legg-Calvé-Perthes disease occurs when there is a temporary loss of blood supply to the femoral head, leading to bone death (necrosis). The exact cause of this vascular disruption is not fully understood, but it may involve genetic, environmental, and mechanical factors. As the blood supply is restored, the body attempts to heal the bone, which can lead to deformity if the process is not managed appropriately.

Symptoms

Children with Legg-Calvé-Perthes disease may present with a variety of symptoms, including:
- Hip Pain: Often described as a dull ache, pain may be localized to the hip but can also radiate to the groin, thigh, or knee.
- Limping: Affected children frequently exhibit a limp, particularly after physical activity.
- Limited Range of Motion: There may be a noticeable reduction in the range of motion in the hip joint, especially in internal rotation and abduction.
- Muscle Atrophy: Over time, disuse of the affected leg can lead to muscle wasting.

Diagnosis

Diagnosis is typically made through a combination of clinical evaluation and imaging studies. Key diagnostic tools include:
- X-rays: Initial imaging may reveal changes in the femoral head, including flattening or fragmentation.
- MRI: Magnetic resonance imaging can provide detailed images of the bone and surrounding soft tissues, helping to assess the extent of necrosis and any associated changes.

ICD-10 Code Details

The ICD-10 code for Juvenile osteochondrosis of the head of the femur is M91.1. This code is part of the broader category of M91, which encompasses various forms of juvenile osteochondrosis affecting the hip and pelvis.

Subcategories

• M91.10: This code is used for unspecified juvenile osteochondrosis of the head of the femur, indicating that the specific details of the condition are not documented.
• M91.11: This code may be used for cases with specific complications or details that further classify the condition.

Treatment

Management of Legg-Calvé-Perthes disease focuses on preserving the shape of the femoral head and maintaining hip function. Treatment options may include:
- Observation: In mild cases, especially in younger children, careful monitoring may be sufficient.
- Physical Therapy: Exercises to improve range of motion and strengthen the hip muscles are often recommended.
- Bracing: In some cases, a brace may be used to keep the hip joint in a proper position.
- Surgery: In more severe cases, surgical intervention may be necessary to correct deformities or improve blood flow to the femoral head.

Conclusion

Legg-Calvé-Perthes disease, classified under ICD-10 code M91.1, is a complex condition that requires careful diagnosis and management. Early intervention is crucial to prevent long-term complications, including hip deformity and osteoarthritis. Understanding the clinical presentation and treatment options is essential for healthcare providers involved in pediatric care.

Juvenile osteochondrosis of the head of the femur, commonly known as Legg-Calvé-Perthes disease (LCPD), is a pediatric condition characterized by the avascular necrosis of the femoral head. This condition typically affects children between the ages of 4 and 10 years and can lead to significant complications if not diagnosed and managed appropriately. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Age and Demographics

• Typical Age Range: LCPD primarily affects children aged 4 to 10 years, with a peak incidence around 6 years of age[1].
• Gender: The condition is more prevalent in boys than girls, with a ratio of approximately 4:1[1].

Risk Factors

• Family History: A positive family history of LCPD or other orthopedic conditions may increase the risk[1].
• Ethnicity: Some studies suggest a higher incidence in Caucasian children compared to other ethnic groups[1].

Signs and Symptoms

Initial Symptoms

• Hip Pain: The most common presenting symptom is hip pain, which may be referred to the groin, thigh, or knee. The pain can be intermittent and may worsen with activity[1][2].
• Limping: Children often present with a limp, which may be more pronounced after physical activity or prolonged periods of weight-bearing[1][2].

Physical Examination Findings

• Limited Range of Motion: On examination, there may be a noticeable reduction in the range of motion of the hip joint, particularly in internal rotation and abduction[1][2].
• Muscle Atrophy: There may be signs of muscle atrophy around the hip and thigh due to disuse[1].
• Tenderness: Tenderness may be elicited over the hip joint during palpation[1].

Advanced Symptoms

• Progressive Symptoms: As the disease progresses, symptoms may include increased pain, stiffness, and further limitation of hip movement. In severe cases, the child may refuse to bear weight on the affected leg[1][2].
• Complications: If left untreated, LCPD can lead to deformities of the femoral head, resulting in early osteoarthritis and chronic pain in adulthood[1].

Diagnostic Considerations

Imaging Studies

• X-rays: Initial imaging typically includes X-rays of the hip, which may show changes in the shape of the femoral head and joint space narrowing[1][2].
• MRI: Magnetic resonance imaging (MRI) can be utilized to assess the extent of avascular necrosis and to evaluate the condition of the cartilage[1].

Differential Diagnosis

• Conditions that may mimic LCPD include transient synovitis, septic arthritis, and other forms of hip pathology. A thorough clinical evaluation and imaging are essential for accurate diagnosis[1][2].

Conclusion

Legg-Calvé-Perthes disease is a significant pediatric orthopedic condition that requires early recognition and management to prevent long-term complications. Understanding the clinical presentation, signs, symptoms, and patient characteristics is crucial for healthcare providers. Early intervention can lead to better outcomes, including the preservation of hip function and reduction of pain. If you suspect a child may have LCPD, prompt referral to a pediatric orthopedic specialist is recommended for further evaluation and management.

Juvenile osteochondrosis of the head of the femur, commonly known as Legg-Calvé-Perthes disease, is a condition that affects the hip joint in children. This condition is characterized by the temporary loss of blood supply to the femoral head, leading to bone death and subsequent regeneration. Below are alternative names and related terms associated with ICD-10 code M91.1.

Alternative Names

1. Legg-Calvé-Perthes Disease: This is the most widely recognized name for the condition, named after the three physicians who described it.
2. Perthes Disease: A shortened version of the full name, commonly used in clinical settings.
3. Coxa plana: This term refers to the flattening of the femoral head that occurs in this condition.
4. Avascular necrosis of the femoral head: While this term is broader, it describes the underlying mechanism of bone death due to lack of blood supply, which is central to Legg-Calvé-Perthes disease.

Related Terms

1. Osteochondrosis: A general term for a group of disorders that affect the growth of bones in children and adolescents, including Legg-Calvé-Perthes disease.
2. Hip joint disorders: This encompasses various conditions affecting the hip, including Legg-Calvé-Perthes disease.
3. Pediatric hip disease: A broader category that includes various hip conditions in children, of which Legg-Calvé-Perthes is a significant example.
4. Femoral head necrosis: This term describes the death of bone tissue in the femoral head, which is a critical aspect of Legg-Calvé-Perthes disease.

Conclusion

Understanding the alternative names and related terms for ICD-10 code M91.1 is essential for accurate diagnosis, treatment, and communication among healthcare professionals. These terms help in identifying the condition in various contexts, whether in clinical practice, research, or patient education.

The diagnosis of Legg-Calvé-Perthes disease, classified under ICD-10 code M91.1 (Juvenile osteochondrosis of head of femur), involves a combination of clinical evaluation, imaging studies, and specific diagnostic criteria. Below is a detailed overview of the criteria and methods used for diagnosing this condition.

Clinical Presentation

Symptoms

Patients with Legg-Calvé-Perthes disease typically present with the following symptoms:
- Hip Pain: Often localized to the groin, thigh, or knee, which may worsen with activity.
- Limping: A noticeable limp may develop due to pain or limited range of motion.
- Limited Range of Motion: Particularly in hip abduction and internal rotation.
- Muscle Atrophy: Over time, there may be muscle wasting in the affected leg due to disuse.

Age Group

Legg-Calvé-Perthes disease primarily affects children, typically between the ages of 4 and 10 years, with a higher prevalence in boys than girls[1].

Diagnostic Imaging

X-rays

• Initial Imaging: X-rays are often the first imaging modality used. They can reveal changes in the shape of the femoral head, joint space narrowing, and other signs of osteonecrosis.
• Progressive Changes: As the disease progresses, X-rays may show fragmentation of the femoral head and changes in bone density.

MRI

• Advanced Imaging: Magnetic Resonance Imaging (MRI) is more sensitive than X-rays and can detect early changes in the femoral head, including edema and necrosis, before they become apparent on X-rays[2].
• Assessment of Extent: MRI can also help assess the extent of the disease and guide treatment decisions.

Diagnostic Criteria

Clinical Criteria

• History and Physical Examination: A thorough history and physical examination are crucial. The presence of hip pain, limping, and limited range of motion should be documented.
• Exclusion of Other Conditions: It is essential to rule out other causes of hip pain in children, such as septic arthritis, transient synovitis, or other forms of osteochondritis.

Imaging Criteria

• X-ray Findings: The presence of characteristic changes in the femoral head on X-ray, such as flattening or fragmentation, supports the diagnosis.
• MRI Findings: MRI findings consistent with avascular necrosis of the femoral head can confirm the diagnosis, especially in early cases where X-ray changes may not yet be evident.

Conclusion

The diagnosis of Legg-Calvé-Perthes disease (ICD-10 code M91.1) relies on a combination of clinical symptoms, age considerations, and imaging studies. Early diagnosis is crucial for effective management and to minimize long-term complications, such as hip deformity and osteoarthritis. If you suspect a case of Legg-Calvé-Perthes disease, a referral to a pediatric orthopedic specialist is often warranted for further evaluation and management[3].

References

1. Network Analysis of Legg–Calve–Perthes Disease and Its ...
2. Legg-Calvé-Perthes disease and the risk of ADHD, ...
3. Analysis of Tertiary Hospital Utilization in Pediatric ...

Juvenile osteochondrosis of the head of the femur, commonly known as Legg-Calvé-Perthes disease (LCPD), is a condition that affects the hip joint in children, leading to avascular necrosis of the femoral head. The treatment for this condition varies based on the severity of the disease, the age of the child, and the extent of hip involvement. Below is a comprehensive overview of standard treatment approaches for LCPD, categorized into non-surgical and surgical options.

Non-Surgical Treatment Approaches

1. Observation

In mild cases, particularly in younger children (typically under 6 years old), doctors may recommend a period of observation. This approach involves regular follow-up appointments to monitor the condition without immediate intervention, as many children experience spontaneous recovery.

2. Activity Modification

Children with LCPD are often advised to limit high-impact activities that could exacerbate hip pain or further damage the femoral head. Activities such as running, jumping, or sports that involve significant hip movement may be restricted.

3. Physical Therapy

Physical therapy plays a crucial role in the management of LCPD. A physical therapist can design a program that focuses on:
- Strengthening exercises: To improve the muscles around the hip joint.
- Range of motion exercises: To maintain flexibility and prevent stiffness.
- Gait training: To help the child walk properly and reduce stress on the hip.

4. Bracing

In some cases, a brace or orthotic device may be used to keep the hip joint in a stable position. The most common type is the abduction brace, which helps maintain the femoral head within the acetabulum (hip socket) and promotes proper alignment.

5. Pain Management

Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), may be recommended to manage pain and inflammation associated with the condition.

Surgical Treatment Approaches

When non-surgical methods are insufficient, particularly in older children or those with more severe cases, surgical intervention may be necessary. The following are common surgical options:

1. Osteotomy

Osteotomy involves cutting and repositioning the femur or pelvis to improve the alignment of the hip joint. This procedure can help redistribute weight and reduce stress on the femoral head, promoting better healing.

2. Core Decompression

This procedure involves drilling a small hole into the femoral head to relieve pressure and improve blood flow to the area. It is often used in cases where the blood supply to the femoral head is compromised.

3. Femoral Head Resurfacing

In more severe cases, resurfacing the femoral head may be performed to remove damaged bone and cartilage, allowing for the growth of new, healthy tissue.

4. Total Hip Replacement

In rare cases where the femoral head is severely damaged and other treatments have failed, a total hip replacement may be considered, particularly in older adolescents.

Conclusion

The management of Legg-Calvé-Perthes disease is tailored to the individual needs of the child, taking into account factors such as age, severity of the disease, and overall health. Non-surgical treatments are often effective, especially in younger children, while surgical options are reserved for more severe cases. Regular follow-up with healthcare providers is essential to monitor the condition and adjust treatment as necessary. Early intervention and appropriate management can lead to favorable outcomes, allowing children to return to normal activities and minimize long-term complications associated with the disease.