ICD-10: M91.11

Juvenile osteochondrosis of the head of the femur, commonly known as Legg-Calvé-Perthes disease, is a condition that primarily affects children and involves the disruption of blood supply to the femoral head, leading to avascular necrosis. The diagnosis of this condition, particularly for the ICD-10 code M91.11, involves several criteria and diagnostic steps.

Diagnostic Criteria for Legg-Calvé-Perthes Disease

Clinical Presentation

1. Age Group: Typically affects children between the ages of 4 and 10 years, with a higher prevalence in boys than girls[1].
2. Symptoms: Common symptoms include:
   - Hip pain, which may be referred to the knee.
   - Limping or altered gait.
   - Limited range of motion in the hip joint.
   - Pain that worsens with activity and improves with rest[1][2].

Physical Examination

1. Hip Examination: A thorough physical examination is crucial. The clinician will assess:
   - Range of motion in the hip joint.
   - Presence of tenderness over the hip or groin area.
   - Any signs of muscle atrophy in the affected leg[2].
2. Gait Analysis: Observing the child’s gait can reveal limping or compensatory movements due to pain or discomfort[1].

Imaging Studies

1. X-rays: Initial imaging typically involves plain radiographs of the hip, which may show:
   - Changes in the shape of the femoral head.
   - Joint space narrowing.
   - Sclerosis or fragmentation of the femoral head[2][3].
2. MRI: Magnetic Resonance Imaging (MRI) can provide more detailed information about the condition, including:
   - Early signs of avascular necrosis.
   - Assessment of the extent of bone involvement and any associated edema[3].
3. CT Scans: In some cases, a CT scan may be used to evaluate the morphology of the femoral head and the degree of deformity[3].

Differential Diagnosis

It is essential to rule out other conditions that may present similarly, such as:
- Septic arthritis.
- Osteomyelitis.
- Slipped capital femoral epiphysis (SCFE).
- Other forms of hip dysplasia or trauma[2][3].

Laboratory Tests

While not routinely required for the diagnosis of Legg-Calvé-Perthes disease, laboratory tests may be performed to rule out inflammatory or infectious processes if indicated by the clinical picture[1].

Conclusion

The diagnosis of juvenile osteochondrosis of the head of the femur (Legg-Calvé-Perthes disease) for the ICD-10 code M91.11 involves a combination of clinical evaluation, imaging studies, and exclusion of other potential conditions. Early diagnosis and intervention are crucial to managing the disease effectively and minimizing long-term complications, such as hip deformity and osteoarthritis. If you suspect this condition, it is advisable to consult a pediatric orthopedic specialist for a comprehensive evaluation and management plan.

Juvenile osteochondrosis of the head of the femur, commonly referred to as Legg-Calvé-Perthes disease, is a condition that primarily affects children, typically between the ages of 4 and 10 years. This condition is characterized by a temporary loss of blood supply to the femoral head, leading to avascular necrosis. The ICD-10 code M91.11 specifically denotes this condition when it occurs in the right leg.

Clinical Description

Pathophysiology

Legg-Calvé-Perthes disease involves a disruption in the blood flow to the femoral head, which is the ball part of the hip joint. This disruption can lead to the death of bone tissue (necrosis) and subsequent deformation of the femoral head. The exact cause of this condition remains unclear, but it is believed to involve a combination of genetic, environmental, and possibly traumatic factors.

Symptoms

Children with M91.11 may present with a variety of symptoms, including:
- Hip Pain: Often described as a dull ache, which may be referred to the knee or groin.
- 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, the muscles around the hip may weaken due to disuse.

Diagnosis

Diagnosis of Legg-Calvé-Perthes disease typically involves:
- Clinical Examination: Assessment of symptoms and physical examination to evaluate hip movement and pain.
- Imaging Studies: X-rays are commonly used to visualize changes in the femoral head. MRI may also be employed for a more detailed assessment of the bone and surrounding tissues.

Treatment Options

Conservative Management

Initial treatment often focuses on non-surgical approaches, including:
- Activity Modification: Limiting weight-bearing activities to reduce stress on the hip joint.
- Physical Therapy: Exercises to maintain hip mobility and strengthen surrounding muscles.
- Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate pain and inflammation.

Surgical Intervention

In more severe cases or when conservative management fails, surgical options may be considered, such as:
- Osteotomy: A procedure to realign the femoral head and improve its fit within the hip socket.
- Core Decompression: A technique to relieve pressure within the femoral head and promote blood flow.

Prognosis

The prognosis for children with M91.11 varies based on the age of onset and the severity of the disease. Early diagnosis and appropriate management can lead to favorable outcomes, with many children experiencing a return to normal function. However, some may develop long-term complications, including hip arthritis later in life.

Conclusion

ICD-10 code M91.11 encapsulates the clinical aspects of juvenile osteochondrosis of the head of the femur in the right leg, specifically relating to Legg-Calvé-Perthes disease. Understanding the pathophysiology, symptoms, diagnostic methods, and treatment options is crucial for effective management and improved outcomes for affected children. Early intervention remains key to minimizing complications and ensuring optimal recovery.

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 M91.11.

Clinical Presentation

Age and Demographics

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

Affected Side

• Laterality: The ICD-10 code M91.11 specifically refers to the right leg, indicating that the right femoral head is affected. However, LCPD can also occur bilaterally in some cases, affecting both hips[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. Children may complain of discomfort during activities or at rest.
• Limping: A noticeable limp is often observed, particularly during walking or running. This is due to pain and reduced range of motion in the hip joint[2].

Physical Examination Findings

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

Progression of Symptoms

• Chronic Symptoms: Over time, symptoms may become chronic, with persistent pain and functional limitations. Children may exhibit decreased activity levels due to discomfort.
• Complications: If left untreated, LCPD can lead to deformities of the femoral head, resulting in osteoarthritis and long-term joint dysfunction[3].

Patient Characteristics

Risk Factors

• Family History: A family history of LCPD or other orthopedic conditions may increase the risk of developing the disease.
• Ethnicity: Some studies suggest that LCPD is more common in Caucasian children compared to other ethnic groups[3].

Comorbidities

• Developmental Delays: Some children with LCPD may have associated developmental delays or other musculoskeletal disorders, which can complicate the clinical picture[2].

Psychosocial Impact

• Emotional and Social Effects: The condition can impact a child's emotional well-being and social interactions, as limitations in physical activity may lead to feelings of isolation or frustration[3].

Conclusion

Legg-Calvé-Perthes disease (ICD-10 code M91.11) is a significant pediatric condition that requires early recognition and management to prevent long-term complications. Understanding the clinical presentation, including the characteristic signs and symptoms, as well as the typical patient demographics, 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, a thorough clinical evaluation and appropriate imaging studies are essential for diagnosis and treatment planning.

References

1. ICD-10 International Statistical Classification of Diseases and Related Health Problems.
2. Analysis of Tertiary Hospital Utilization in Pediatric Orthopedics.
3. Legg-Calvé-Perthes Disease and the Risk of Injuries: A Comprehensive Review.

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 M91.11 specifically refers to this condition when it occurs in the right 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 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: This term describes the underlying pathology where blood supply to the femoral head is compromised, leading to bone death.

Related Terms

1. Osteochondritis: A broader term that refers to inflammation of the bone and cartilage, which can include conditions like Perthes disease.
2. Hip osteochondrosis: This term encompasses various osteochondrosis conditions affecting the hip joint, including Legg-Calvé-Perthes disease.
3. Childhood hip disorders: A general category that includes various conditions affecting the hip in children, including Perthes disease.
4. Femoral head necrosis: This term describes the necrosis that occurs in the femoral head due to insufficient blood supply, which is a key feature of Legg-Calvé-Perthes disease.

Conclusion

Understanding the alternative names and related terms for ICD-10 code M91.11 is essential for accurate diagnosis and treatment. These terms are often used interchangeably in medical literature and clinical practice, highlighting the importance of recognizing the condition's various aspects. If you need further information on treatment options or management strategies for this condition, feel free to ask!

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 ICD-10 code M91.11 specifically refers to this condition in the right leg. Understanding the standard treatment approaches for this condition is crucial for effective management and recovery.

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 exact cause of LCPD is not fully understood, but it is believed to involve a combination of genetic, environmental, and possibly traumatic factors. Symptoms often include hip pain, limping, and limited range of motion.

Standard Treatment Approaches

1. Observation and Activity Modification

In mild cases, especially in younger children, the initial approach may involve careful observation. Activity modification is recommended to reduce stress on the hip joint. This includes:

• Limiting weight-bearing activities: Children may be advised to avoid running, jumping, or other high-impact activities that could exacerbate symptoms.
• Encouraging low-impact activities: Swimming and cycling can be beneficial as they place less stress on the hip joint.

2. Physical Therapy

Physical therapy plays a vital role in the management of LCPD. A physical therapist can design a program that focuses on:

• Strengthening exercises: To improve the strength of the muscles around the hip joint.
• Range of motion exercises: To maintain flexibility and prevent stiffness.
• 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 help maintain proper hip positioning and reduce pain. Common devices include:

• Abduction braces: These help keep the hip in a position that promotes better blood flow to the femoral head.
• Pavlik harness: Although more commonly used for developmental dysplasia of the hip, it may be adapted for certain cases of LCPD.

4. Medications

Pain management is an essential aspect of treatment. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be prescribed to alleviate pain and reduce inflammation. In some cases, corticosteroids may be considered, but their use is generally limited due to potential side effects.

5. Surgical Interventions

If conservative treatments fail to provide relief or if the disease progresses, surgical options may be considered. Surgical interventions can include:

• 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: This technique involves removing a portion of the bone to relieve pressure and promote blood flow to the femoral head.

6. Follow-Up and Monitoring

Regular follow-up appointments are crucial to monitor the progression of the disease and the effectiveness of the treatment plan. X-rays or MRI scans may be used to assess changes in the femoral head and joint structure over time.

Conclusion

The management of Legg-Calvé-Perthes disease (ICD-10 code M91.11) involves a multidisciplinary approach tailored to the individual child's needs. Early diagnosis and intervention are key to optimizing outcomes and minimizing long-term complications. Parents and caregivers should work closely with healthcare providers to ensure that the child receives appropriate treatment and support throughout the recovery process. Regular monitoring and adjustments to the treatment plan may be necessary as the child grows and the condition evolves.