ICD-10: M91.12

Juvenile osteochondrosis of the head of the femur, commonly referred to as Legg-Calvé-Perthes disease, is a condition that primarily affects children and is characterized by the disruption of blood supply to the femoral head, leading to avascular necrosis. The ICD-10 code M91.12 specifically denotes this condition when it occurs in the left leg.

Clinical Description

Definition

Legg-Calvé-Perthes disease is a pediatric hip disorder that results from the temporary loss of blood supply to the femoral head, which can lead to bone death (necrosis) and subsequent deformity. This condition typically manifests in children aged 4 to 10 years, with a higher prevalence in boys than girls.

Pathophysiology

The exact cause of Legg-Calvé-Perthes disease remains unclear, but it is believed to involve a combination of genetic, environmental, and possibly traumatic factors that affect the blood supply to the femoral head. The lack of blood flow leads to the death of bone cells, which can result in the collapse of the femoral head and subsequent joint dysfunction.

Symptoms

Children with M91.12 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: Difficulty in moving the hip, 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, physical examination, and observation of gait.
- Imaging Studies: X-rays are commonly used to visualize changes in the femoral head, while MRI may be employed for a more detailed assessment of bone and soft tissue.

Treatment

Management of M91.12 focuses on preserving hip function and preventing further joint damage. Treatment options may include:
- Observation: In mild cases, monitoring the condition may be sufficient.
- Physical Therapy: To improve range of motion and strengthen surrounding muscles.
- Bracing: Use of a brace to maintain proper hip positioning.
- Surgery: In severe cases, surgical intervention may be necessary to realign the femoral head or to address any deformities.

Conclusion

ICD-10 code M91.12 captures the clinical essence of juvenile osteochondrosis of the head of the femur, specifically for the left leg. Understanding this condition is crucial for timely diagnosis and effective management, which can significantly impact the long-term outcomes for affected children. Early intervention and appropriate treatment strategies are essential to minimize complications and promote optimal hip function as the child grows.

Juvenile osteochondrosis of the head of the femur, commonly known as Legg-Calvé-Perthes disease (LCPD), is a condition that primarily affects children and is characterized by the avascular necrosis of the femoral head. This condition 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 M91.12, which specifically refers to LCPD affecting the left leg.

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].

Symptoms

• Hip Pain: The most common symptom is hip pain, which may be referred to the groin, thigh, or knee. Children often describe the pain as dull and intermittent, worsening with activity.
• Limping: A noticeable limp is frequently observed, particularly after physical activity. This is often due to pain or mechanical instability in the hip joint.
• Limited Range of Motion: Children may exhibit reduced internal rotation and abduction of the hip joint, which can be assessed during a physical examination.
• Muscle Atrophy: Over time, disuse of the affected leg may lead to muscle wasting, particularly in the thigh and hip area.

Signs

• Tenderness: Upon examination, tenderness may be noted over the hip joint.
• Decreased Mobility: The child may resist movement of the hip joint due to pain, leading to a characteristic "guarding" posture.
• Leg Length Discrepancy: In some cases, there may be a slight discrepancy in leg length due to the disease's effects on bone growth.

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 a higher prevalence in certain ethnic groups, although the reasons for this are not fully understood.
• Previous Trauma: While not a direct cause, a history of hip trauma may be associated with the onset of symptoms.

Comorbidities

• Developmental Dysplasia of the Hip (DDH): Children with a history of DDH may be at increased risk for developing LCPD.
• Other Orthopedic Conditions: Conditions such as Perthes disease can co-occur with other musculoskeletal disorders, complicating the clinical picture.

Conclusion

Legg-Calvé-Perthes disease is a significant pediatric orthopedic condition that requires early recognition and management to prevent long-term complications such as osteoarthritis or femoral head deformity. The clinical presentation typically includes hip pain, limping, and limited range of motion, primarily affecting boys aged 4 to 10 years. Early diagnosis through clinical evaluation and imaging studies is crucial for effective treatment and improved outcomes for affected children. If you suspect a child may have LCPD, it is essential to consult a healthcare professional for a comprehensive assessment and appropriate management strategies.

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 M91.12 specifically refers to this condition when it occurs in the left 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, 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 broader, it describes the underlying pathology of the disease, where the blood supply to the femoral head is compromised, leading to bone death.

Related Terms

1. Osteochondritis: A general term that refers to inflammation of the bone and cartilage, which can be related to various conditions, including 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 broader category that includes various conditions affecting the hip in children, of which Perthes disease is a significant example.
4. Femoral head necrosis: This term describes the necrosis that occurs in the femoral head due to the lack of blood supply, a key feature of Legg-Calvé-Perthes disease.

Conclusion

Understanding the alternative names and related terms for ICD-10 code M91.12 can enhance communication among healthcare professionals and improve patient education. Recognizing these terms can also aid in the diagnosis and treatment of this condition, ensuring that children receive appropriate care for their hip health. If you have further questions or need more specific information, feel free to ask!

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 M91.12, which specifies the left leg, involves several criteria and diagnostic steps.

Diagnostic Criteria for Legg-Calvé-Perthes Disease

Clinical Presentation

1. Age Group: Typically affects children aged 4 to 10 years, with a higher prevalence in boys than girls[1].
2. Symptoms: Common symptoms include:
   - Hip pain or discomfort, which may be referred to the knee.
   - Limping or altered gait.
   - Limited range of motion in the hip joint.
   - Muscle atrophy around the hip due to disuse[2].

Physical Examination

1. Gait Analysis: Observation of the child’s gait can reveal limping or a trendelenburg gait, which indicates weakness in the hip abductor muscles.
2. Range of Motion: A thorough examination of hip mobility is essential, as there may be restrictions in internal rotation and abduction[3].

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.
   - Increased radiolucency or flattening of the femoral head.
   - Joint space widening or effusion[4].
2. MRI: Magnetic Resonance Imaging (MRI) can be utilized for a more detailed assessment, particularly to evaluate the extent of avascular necrosis and to visualize the bone marrow edema associated with the condition[5].

Differential Diagnosis

It is crucial to differentiate Legg-Calvé-Perthes disease from other conditions that may present similarly, such as:
- Septic arthritis.
- Osteomyelitis.
- Slipped capital femoral epiphysis (SCFE).
- Other forms of osteochondritis[6].

Laboratory Tests

While laboratory tests are not typically definitive for diagnosing Legg-Calvé-Perthes disease, they may be used to rule out other conditions. Blood tests can help identify signs of infection or inflammation if septic arthritis is suspected[7].

Conclusion

The diagnosis of juvenile osteochondrosis of the head of the femur (Legg-Calvé-Perthes disease) for the ICD-10 code M91.12 involves a combination of clinical evaluation, imaging studies, and consideration of differential diagnoses. Early diagnosis and intervention are crucial to prevent long-term complications, including hip deformity and osteoarthritis. If you suspect this condition, it is essential to consult a healthcare professional for a comprehensive evaluation and management plan.

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. It occurs when the blood supply to the femoral head is temporarily disrupted, leading to bone death and subsequent regeneration. The ICD-10 code M91.12 specifically refers to this condition in the left leg. Here, we will explore the standard treatment approaches for this condition.

Overview of Legg-Calvé-Perthes Disease

LCPD typically affects children between the ages of 4 and 10, with boys being more frequently affected than girls. The exact cause of the disease 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 in the affected leg.

Standard Treatment Approaches

1. Observation and Activity Modification

In mild cases, especially in younger children (under 6 years), the initial approach may involve careful observation. Parents are advised to modify the child's activities to avoid high-impact sports and activities that could exacerbate symptoms. This conservative management allows for natural healing and monitoring of the condition.

2. 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 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 walk properly and reduce limping.

3. Bracing

In some cases, a brace may be recommended to help maintain the hip in a proper position. The most common type of brace used is the abduction brace, which keeps the hip in a position that promotes optimal blood flow to the femoral head. This can help in maintaining the shape of the femoral head as it heals.

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, although their use is less common due to potential side effects.

5. Surgical Intervention

Surgery may be indicated in more severe cases or when conservative treatments fail to provide relief. Surgical options 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 improve blood flow to the femoral head.

6. Follow-Up and Monitoring

Regular follow-up appointments with an orthopedic specialist 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 the healing process and the shape of the femoral head.

Conclusion

The management of Legg-Calvé-Perthes disease (ICD-10 code M91.12) involves a combination of conservative and, in some cases, surgical approaches tailored to the severity of the condition and the age of the child. Early diagnosis and intervention are key to optimizing outcomes and minimizing long-term complications. Parents should work closely with healthcare providers to develop a comprehensive treatment plan that addresses their child's specific needs. Regular monitoring and adjustments to the treatment strategy are essential to ensure the best possible recovery.