ICD-10: M91.10

Juvenile osteochondrosis of the head of the femur, commonly known as Legg-Calvé-Perthes disease, is a condition that primarily affects children, leading to a disruption of blood supply to the femoral head. This condition is classified under the ICD-10 code M91.10, which specifically denotes "Juvenile osteochondrosis of head of femur [Legg-Calvé-Perthes], unspecified leg" [1][2].

Clinical Description

Definition and Pathophysiology

Legg-Calvé-Perthes disease is characterized by avascular necrosis of the femoral head, which occurs when the blood supply to the area is temporarily disrupted. This lack of blood flow leads to the death of bone tissue, resulting in the collapse of the femoral head. The exact cause of this disruption is not fully understood, but it is believed to involve a combination of genetic, environmental, and possibly traumatic factors [1][2].

Epidemiology

This condition predominantly affects children between the ages of 4 and 10 years, with a higher incidence in boys than girls. The prevalence varies by geographic location and ethnicity, with some studies indicating a higher occurrence in Caucasian children compared to other ethnic groups [1][2].

Symptoms

Children with Legg-Calvé-Perthes disease may present with a variety of symptoms, including:
- Hip Pain: Often described as a dull ache, which may be localized to the hip or referred to the knee.
- Limping: A noticeable limp may develop due to pain or stiffness in the hip joint.
- Limited Range of Motion: Children may exhibit reduced mobility in the hip joint, particularly in internal rotation and abduction.
- Muscle Atrophy: Over time, disuse of the affected leg may lead to muscle wasting [1][2].

Diagnosis

Diagnosis typically involves a combination of clinical evaluation and imaging studies. Key diagnostic tools include:
- X-rays: Initial imaging to assess the shape and integrity of the femoral head.
- MRI: More sensitive in detecting early changes in the bone and surrounding soft tissues, particularly in the early stages of the disease [1][2].

Treatment Options

Conservative Management

In many cases, treatment may be conservative, focusing on:
- Activity Modification: Reducing high-impact activities to alleviate pain and prevent further damage.
- Physical Therapy: Exercises to maintain hip mobility and strengthen surrounding muscles.

Surgical Intervention

In more severe cases or when conservative measures fail, surgical options may be considered, including:
- Osteotomy: Realigning the femur to improve the fit of the hip joint.
- Core Decompression: Relieving pressure within the femoral head to promote blood flow and healing [1][2].

Prognosis

The prognosis for children with Legg-Calvé-Perthes disease varies. Many children experience a good outcome with appropriate management, although some may develop residual hip problems or early osteoarthritis later in life. Early diagnosis and intervention are crucial for optimizing long-term joint function and minimizing complications [1][2].

In summary, ICD-10 code M91.10 encapsulates a significant pediatric orthopedic condition that requires careful clinical assessment and management to ensure the best possible outcomes for affected children.

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 primarily affects children 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 ICD-10 code M91.10.

Clinical Presentation

Age and Demographics

Legg-Calvé-Perthes disease typically presents in children between the ages of 4 and 10 years, with a higher prevalence in boys than girls, with a ratio of approximately 4:1[1]. The exact etiology remains unclear, but genetic and environmental factors may contribute to its development.

Symptoms

The symptoms of LCPD can vary in severity and may include:

• Hip Pain: The most common symptom, often described as a dull ache in the hip, groin, or knee. Pain may worsen with activity and improve with rest[2].
• Limping: A noticeable limp is often observed, particularly during walking or running. This is due to pain and limited range of motion in the affected hip[3].
• Limited Range of Motion: Children may exhibit reduced internal rotation and abduction of the hip joint, which can be assessed during a physical examination[4].
• Muscle Atrophy: Over time, disuse of the affected leg may lead to muscle wasting, particularly in the thigh and buttock areas[5].

Signs

On physical examination, clinicians may note:

• Tenderness: Palpation of the hip joint may elicit tenderness, particularly over the greater trochanter[6].
• Decreased Mobility: Observations of restricted movement in the hip joint, especially during internal rotation and abduction[7].
• Leg Length Discrepancy: In some cases, there may be a noticeable difference in leg length due to the disease's impact on bone growth[8].

Patient Characteristics

Risk Factors

Certain factors may increase the likelihood of developing LCPD, including:

• Family History: A familial predisposition has been noted, suggesting a genetic component to the disease[9].
• Low Birth Weight: Some studies indicate that children with a history of low birth weight may be at higher risk[10].
• Environmental Factors: Exposure to secondhand smoke and other environmental toxins has been suggested as potential risk factors[11].

Comorbidities

Children with LCPD may also present with other conditions, such as:

• Developmental Dysplasia of the Hip (DDH): A history of hip dysplasia may be associated with an increased risk of LCPD[12].
• Obesity: Excess weight can exacerbate symptoms and complicate the management of the disease[13].

Conclusion

Legg-Calvé-Perthes disease is a significant pediatric condition that requires early recognition and intervention to prevent long-term complications, such as osteoarthritis and hip deformity. Clinicians should be vigilant in assessing children presenting with hip pain, limping, or decreased range of motion, particularly those within the typical age range and with risk factors. Early diagnosis through imaging studies, such as X-rays or MRI, is crucial for effective management and treatment planning.

For further management, referral to a pediatric orthopedic specialist may be necessary to explore treatment options, which can range from conservative management to surgical interventions, depending on the severity of the disease and the age of the child[14].

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. The ICD-10 code M91.10 specifically refers to this condition when it is unspecified for the leg. Below are alternative names and related terms associated with this diagnosis.

Alternative Names

1. Legg-Calvé-Perthes Disease: This is the most widely recognized name for the condition, named after the three physicians who first described it.
2. Perthes Disease: A shortened version of Legg-Calvé-Perthes disease, often 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 more general, it describes the underlying pathology of the disease, where the blood supply to the femoral head is compromised.

Related Terms

1. Osteochondritis: A broader term that refers to inflammation of the bone and cartilage, which can include conditions like Legg-Calvé-Perthes disease.
2. Juvenile osteochondrosis: This term encompasses various conditions affecting the growth of bones in children, including Legg-Calvé-Perthes disease.
3. Hip osteonecrosis: This term describes the death of bone tissue in the hip joint, which is a critical aspect of Legg-Calvé-Perthes disease.
4. Femoral head avascular necrosis: A specific term that highlights the necrosis of the femoral head, which is central to the pathology of the disease.

Conclusion

Understanding the alternative names and related terms for ICD-10 code M91.10 is essential for accurate diagnosis and communication in clinical settings. These terms not only help in identifying the condition but also in discussing its implications and treatment options effectively. If you need further information on treatment or management strategies for Legg-Calvé-Perthes disease, feel free to ask!

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. The diagnosis of this condition, particularly for the ICD-10 code M91.10, involves several criteria that healthcare professionals typically consider. Below is a detailed overview of the diagnostic criteria and relevant considerations.

Clinical Presentation

Symptoms

• Hip Pain: Children may present with hip pain that can radiate to the groin, thigh, or knee.
• Limping: A noticeable limp is often observed, which may worsen with activity.
• Limited Range of Motion: There may be a reduction in the range of motion in the hip joint, particularly in internal rotation and abduction.

Age Group

• Typical Age Range: The condition primarily affects children aged 4 to 10 years, with a peak incidence around 6 years of age.

Diagnostic Imaging

X-rays

• Initial Imaging: X-rays are typically 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 often utilized for a more detailed assessment. It can detect early changes in the bone marrow and provide information about the extent of necrosis before changes are visible on X-rays.

Exclusion of Other Conditions

Differential Diagnosis

• Ruling Out Other Causes: It is crucial to exclude other potential causes of hip pain in children, such as septic arthritis, transient synovitis, or other forms of osteochondritis. This is often done through clinical evaluation and imaging studies.

Clinical Examination

Physical Examination

• Assessment of Hip Function: A thorough physical examination is conducted to assess the hip's range of motion, strength, and any signs of atrophy in the surrounding muscles.
• Observation of Gait: The child's gait is observed for abnormalities, which can provide additional clues to the diagnosis.

Summary of Diagnostic Criteria

In summary, the diagnosis of Legg-Calvé-Perthes disease (ICD-10 code M91.10) is based on a combination of clinical symptoms, age, imaging findings, and the exclusion of other conditions. The following criteria are typically used:

1. Age: Primarily affects children aged 4 to 10 years.
2. Symptoms: Presence of hip pain, limping, and limited range of motion.
3. Imaging: X-rays and/or MRI showing characteristic changes in the femoral head.
4. Exclusion of Other Conditions: Ruling out other potential causes of hip pain through clinical evaluation and imaging.

These criteria help ensure an accurate diagnosis, which is essential for effective management and treatment of the condition. Early diagnosis and intervention can significantly improve outcomes for children affected by this disease.

Juvenile osteochondrosis of the head of the femur, commonly known as Legg-Calvé-Perthes disease (LCPD), is a condition that primarily affects 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 femoral head involvement. Below, we explore standard treatment approaches for LCPD, particularly for cases classified under ICD-10 code M91.10.

Overview of Legg-Calvé-Perthes Disease

LCPD typically occurs in children aged 4 to 10 years and is characterized by a temporary loss of blood supply to the femoral head, resulting in bone death and subsequent deformity. The condition can lead to pain, limping, and limited range of motion in the hip joint. Early diagnosis and intervention are crucial to prevent long-term complications, including osteoarthritis.

Standard Treatment Approaches

1. Observation and Activity Modification

In mild cases, especially in younger children (under 6 years), a conservative approach may be adopted. This includes:

• Activity Modification: Limiting high-impact activities and encouraging low-impact exercises to reduce stress on the hip joint.
• Observation: Regular follow-ups to monitor the progression of the disease through physical examinations and imaging studies.

2. Physical Therapy

Physical therapy plays a vital role in the management of LCPD. It focuses on:

• Strengthening Exercises: To improve the strength of the hip and surrounding muscles.
• Range of Motion Exercises: To maintain flexibility and prevent stiffness in the hip joint.
• Gait Training: To help the child develop a more normal walking pattern.

3. Bracing and Orthotic Devices

In some cases, the use of braces or orthotic devices may be recommended to:

• Maintain Hip Positioning: Devices like the abduction brace can help keep the femoral head properly positioned within the acetabulum, promoting better healing.
• Reduce Weight Bearing: Crutches or a wheelchair may be advised to minimize weight on the affected leg during the healing process.

4. Medications

Pain management is essential in treating LCPD. Common medications include:

• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Such as ibuprofen or naproxen, to alleviate pain and reduce inflammation.
• Analgesics: For pain relief, especially during flare-ups.

5. Surgical Interventions

In more severe cases or when conservative treatments fail, surgical options may be considered:

• Osteotomy: This procedure involves cutting and repositioning the femur or pelvis to improve the alignment of the hip joint and redistribute weight more evenly across the joint.
• Core Decompression: A surgical technique that involves removing a portion of the bone to relieve pressure and promote blood flow to the femoral head.

6. Post-Surgical Rehabilitation

Following any surgical intervention, a structured rehabilitation program is crucial to ensure optimal recovery. This may include:

• Continued Physical Therapy: To regain strength and mobility.
• Gradual Return to Activities: Monitoring the child’s progress and gradually reintroducing activities as tolerated.

Conclusion

The management of Legg-Calvé-Perthes disease (ICD-10 code M91.10) is multifaceted, involving a combination of conservative and surgical approaches tailored to the individual needs of the child. Early diagnosis and intervention are key to preventing long-term complications and ensuring the best possible outcomes. Regular follow-up with healthcare providers is essential to monitor the condition and adjust treatment plans as necessary. If you suspect your child may have symptoms of LCPD, consulting a pediatric orthopedic specialist is recommended for a comprehensive evaluation and treatment plan.