ICD-10: M91.2

Coxa plana, classified under ICD-10 code M91.2, refers to a condition characterized by flattening of the femoral head, which can lead to hip joint dysfunction and pain. The diagnosis of coxa plana typically involves a combination of clinical evaluation and imaging studies. Below are the key criteria and methods used for diagnosing this condition.

Clinical Evaluation

1. Patient History:
   - A thorough medical history is essential, focusing on any previous hip injuries, pain patterns, and functional limitations. Patients may report hip pain, limping, or decreased range of motion, particularly in children and adolescents.

2. Physical Examination:
   - The clinician will perform a physical examination to assess hip mobility, strength, and any signs of pain during movement. Specific tests may include:

   • Trendelenburg Test: To evaluate hip stability and gluteal muscle function.
   • Range of Motion Assessment: To determine any limitations in hip flexion, abduction, and internal/external rotation.

Imaging Studies

1. X-rays:
   - Radiographic imaging is crucial for diagnosing coxa plana. X-rays can reveal the characteristic flattening of the femoral head and any associated changes in the hip joint structure. Key findings may include:

   • Decreased sphericity of the femoral head.
   • Alterations in the joint space.
   • Possible signs of avascular necrosis if present.

2. MRI or CT Scans:
   - In some cases, advanced imaging techniques like MRI or CT scans may be utilized to provide a more detailed view of the hip joint and assess the extent of any underlying pathology, such as bone marrow edema or cartilage damage.

Differential Diagnosis

• It is important to differentiate coxa plana from other conditions that may present with similar symptoms, such as:
• Legg-Calvé-Perthes Disease: A condition that also involves avascular necrosis of the femoral head, primarily in children.
• Slipped Capital Femoral Epiphysis (SCFE): A condition where the femoral head slips off the neck of the femur, often seen in adolescents.

Conclusion

The diagnosis of coxa plana (ICD-10 code M91.2) relies on a combination of patient history, physical examination, and imaging studies. Accurate diagnosis is crucial for determining the appropriate management and treatment plan, which may include physical therapy, surgical intervention, or monitoring, depending on the severity of the condition and the patient's age and activity level. If you suspect coxa plana, it is advisable to consult a healthcare professional for a comprehensive evaluation and diagnosis.

Coxa plana, classified under ICD-10 code M91.2, refers to a specific type of juvenile osteochondrosis affecting the hip joint. This condition is characterized by the flattening of the femoral head, which can lead to hip pain and mobility issues, particularly in children and adolescents.

Clinical Description of Coxa Plana

Definition and Pathophysiology

Coxa plana is a form of osteochondrosis, a group of disorders that result from the disruption of blood supply to the growing bone, leading to necrosis and subsequent deformity. In the case of coxa plana, the femoral head becomes flattened due to the loss of blood supply, which can occur during periods of rapid growth. This condition is most commonly seen in children aged 4 to 10 years and can affect one or both hips.

Symptoms

Patients with coxa plana may present with a variety of symptoms, including:
- Hip Pain: Often localized to the groin or thigh, which may worsen with activity.
- Limited Range of Motion: Difficulty in moving the hip joint, particularly in internal rotation and abduction.
- Limping: A noticeable limp may develop as the child compensates for pain or discomfort.
- Muscle Atrophy: Over time, disuse of the affected limb can lead to muscle wasting.

Diagnosis

Diagnosis of coxa plana typically involves:
- Clinical Examination: Assessment of symptoms, physical examination, and evaluation of hip mobility.
- Imaging Studies: X-rays are crucial for visualizing the femoral head's shape and assessing the extent of flattening. MRI may also be used to evaluate the condition of the bone and surrounding soft tissues.

Treatment

Management of coxa plana focuses on relieving symptoms and preventing further joint damage. Treatment options may include:
- Activity Modification: Reducing weight-bearing activities to alleviate pain.
- Physical Therapy: Exercises to improve range of motion and strengthen surrounding muscles.
- Surgical Intervention: In severe cases, procedures such as osteotomy may be considered to realign the hip joint and restore normal function.

ICD-10 Code Specifics

The ICD-10 code M91.2 is part of a broader classification for juvenile osteochondrosis of the hip and pelvis, specifically indicating coxa plana. The code can be further specified based on laterality:
- M91.21: Coxa plana, right hip
- M91.22: Coxa plana, left hip
- M91.20: Coxa plana, unspecified hip

Clinical Implications

Understanding the clinical implications of coxa plana is essential for healthcare providers, as early diagnosis and intervention can significantly improve outcomes. Regular follow-up and monitoring are crucial to assess the progression of the condition and adjust treatment plans accordingly.

In summary, coxa plana (ICD-10 code M91.2) is a significant pediatric condition that requires careful clinical evaluation and management to prevent long-term complications associated with hip deformity and dysfunction.

Coxa plana, classified under ICD-10 code M91.2, is a condition characterized by the flattening of the femoral head, which can lead to hip joint dysfunction and pain. This condition is most commonly associated with Legg-Calvé-Perthes disease, a childhood hip disorder that affects the blood supply to the femoral head, resulting in avascular necrosis. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with coxa plana is crucial for effective diagnosis and management.

Clinical Presentation

Signs and Symptoms

1. Hip Pain: Patients often report pain in the hip region, which may be localized or referred to the groin, thigh, or knee. The pain can be exacerbated by activity and relieved by rest.
2. Limited Range of Motion: There is typically a noticeable reduction in the range of motion of the hip joint, particularly in internal rotation and abduction. This limitation can affect the patient's ability to perform daily activities.
3. Limping: A common symptom in affected children is a limp, which may be more pronounced during physical activity. The limp can be due to pain or mechanical instability in the hip joint.
4. Muscle Atrophy: Over time, disuse of the affected limb may lead to muscle atrophy, particularly in the thigh and hip muscles.
5. Joint Stiffness: Patients may experience stiffness in the hip joint, especially after periods of inactivity.

Patient Characteristics

• Age: Coxa plana primarily affects children, typically between the ages of 4 and 10 years. It is rare in adults.
• Gender: The condition is more prevalent in males than females, with a male-to-female ratio of approximately 4:1.
• Family History: There may be a genetic predisposition, as coxa plana can occur in families with a history of similar hip disorders.
• Ethnicity: Some studies suggest variations in incidence among different ethnic groups, although more research is needed to clarify these differences.

Diagnosis

Diagnosis of coxa plana involves a combination of clinical evaluation and imaging studies. The following methods are commonly used:

1. Physical Examination: A thorough physical examination is essential to assess hip range of motion, pain response, and gait abnormalities.
2. Imaging Studies: X-rays are the primary imaging modality used to confirm the diagnosis. They can reveal characteristic changes in the femoral head, including flattening and fragmentation. MRI may also be utilized to assess the extent of avascular necrosis and to evaluate the surrounding soft tissues.

Conclusion

Coxa plana, represented by ICD-10 code M91.2, is a significant pediatric condition that requires early recognition and intervention to prevent long-term complications. The clinical presentation typically includes hip pain, limited range of motion, limping, muscle atrophy, and joint stiffness. Understanding the patient characteristics, such as age, gender, and family history, can aid healthcare providers in diagnosing and managing this condition effectively. Early diagnosis and appropriate treatment are crucial to improving outcomes and preserving hip function in affected children.

Coxa plana, represented by the ICD-10 code M91.2, is a condition characterized by flattening of the femoral head, often associated with juvenile osteochondrosis. This condition can lead to hip pain and mobility issues, particularly in children and adolescents. Below are alternative names and related terms associated with Coxa plana.

Alternative Names for Coxa Plana

1. Legg-Calvé-Perthes Disease: This is perhaps the most recognized term associated with coxa plana, particularly in the context of avascular necrosis of the femoral head in children. It describes a specific type of coxa plana that occurs due to interrupted blood supply to the femoral head, leading to its flattening and potential deformity[9].

2. Avascular Necrosis of the Femoral Head: While this term is broader, it encompasses the pathological process that can lead to coxa plana. Avascular necrosis refers to the death of bone tissue due to a lack of blood supply, which can result in the flattening of the femoral head[10].

3. Juvenile Osteochondrosis: This term refers to a group of disorders that affect the growth of bones in children, including coxa plana. It highlights the developmental aspect of the condition, particularly in younger patients[13].

4. Coxa Plana Congenita: This term may be used to describe cases of coxa plana that are present at birth or develop in early childhood, emphasizing its congenital nature[12].

Related Terms

1. Hip Dysplasia: Although not synonymous, hip dysplasia can be related to coxa plana as both conditions affect the hip joint's structure and function. Dysplasia refers to the abnormal development of the hip joint, which can lead to various complications, including coxa plana[11].

2. Osteochondritis Dissecans: This condition involves the separation of a fragment of bone and cartilage from the femoral head, which can be associated with coxa plana in some cases, particularly in adolescents[14].

3. Valgus and Varus Deformities: These terms refer to angular deformities of the limbs that can affect the hip joint's alignment and may be related to the development of coxa plana. Valgus deformity refers to an outward angulation, while varus deformity refers to an inward angulation[5][7].

4. Chondrolysis: This term describes the degeneration of cartilage, which can occur in conjunction with coxa plana and contribute to joint dysfunction and pain[10].

Conclusion

Understanding the alternative names and related terms for ICD-10 code M91.2: Coxa plana is essential for accurate diagnosis and treatment. These terms not only provide insight into the condition itself but also highlight its connections to other orthopedic issues. If you have further questions or need more detailed information about coxa plana or related conditions, feel free to ask!

Coxa plana, classified under ICD-10 code M91.2, refers to a condition characterized by flattening of the femoral head, which can lead to hip joint dysfunction and pain. This condition is often seen in children and can result from various factors, including developmental dysplasia or avascular necrosis. The treatment approaches for coxa plana typically involve a combination of non-surgical and surgical methods, depending on the severity of the condition and the age of the patient.

Non-Surgical Treatment Approaches

1. Observation and Monitoring

In mild cases, especially in younger children, doctors may recommend a watchful waiting approach. Regular monitoring through physical examinations and imaging studies can help assess the progression of the condition without immediate intervention.

2. Physical Therapy

Physical therapy plays a crucial role in managing coxa plana. A tailored exercise program can help strengthen the muscles around the hip joint, improve range of motion, and alleviate pain. Therapists may focus on:
- Strengthening exercises for the hip and leg muscles.
- Stretching exercises to maintain flexibility.
- Gait training to improve walking patterns.

3. Activity Modification

Limiting high-impact activities that place stress on the hip joint is often advised. Patients may be encouraged to engage in low-impact activities, such as swimming or cycling, to maintain fitness without exacerbating the condition.

4. Pain Management

Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), can be used to manage pain and inflammation associated with coxa plana. In some cases, corticosteroid injections may be considered for more severe pain.

Surgical Treatment Approaches

1. Osteotomy

In cases where the femoral head is significantly deformed or if conservative treatments fail, surgical intervention may be necessary. Osteotomy involves cutting and repositioning the bone to improve the alignment of the hip joint. This procedure can help restore the normal shape of the femoral head and improve joint function.

2. Hip Joint Reconstruction

For severe cases, particularly in older children or adolescents, more extensive surgical procedures may be required. This can include hip joint reconstruction, which aims to restore the normal anatomy of the hip joint and improve its function.

3. Total Hip Replacement

In rare and severe cases where the hip joint is irreparably damaged, total hip replacement may be considered. This procedure involves replacing the damaged hip joint with a prosthetic implant, providing pain relief and improved mobility.

Conclusion

The treatment of coxa plana (ICD-10 code M91.2) is tailored to the individual needs of the patient, considering factors such as age, severity of the condition, and overall health. Non-surgical approaches are often effective, particularly in younger patients, while surgical options are reserved for more severe cases. Early diagnosis and intervention are crucial for optimal outcomes, and ongoing monitoring is essential to adapt treatment plans as necessary. If you suspect coxa plana or are experiencing related symptoms, consulting a healthcare professional for a comprehensive evaluation and personalized treatment plan is recommended.