ICD-10: M91.20

Coxa plana, classified under ICD-10-CM code M91.20, refers to a condition characterized by flattening of the femoral head, which can lead to hip joint dysfunction. This condition is often associated with avascular necrosis, where the blood supply to the femoral head is compromised, resulting in bone death and subsequent deformation.

Clinical Description

Definition

Coxa plana is a term used to describe the flattening of the femoral head, which is the ball part of the hip joint. This flattening can lead to joint instability and pain, affecting mobility and overall quality of life. The unspecified nature of the M91.20 code indicates that the specific cause or details of the condition are not documented, which can complicate treatment and management strategies.

Etiology

The etiology of coxa plana can vary, but it is commonly associated with:
- Avascular Necrosis: A condition where the blood supply to the femoral head is interrupted, leading to bone death and deformation.
- Trauma: Injuries to the hip can lead to changes in the structure of the femoral head.
- Congenital Factors: Some individuals may be predisposed to hip deformities due to genetic factors.

Symptoms

Patients with coxa plana may experience a range of symptoms, including:
- Hip Pain: Often exacerbated by weight-bearing activities.
- Limited Range of Motion: Difficulty in moving the hip joint, particularly in flexion and rotation.
- Limping: Altered gait patterns due to pain or instability in the hip joint.

Diagnosis

Diagnosis of coxa plana typically involves:
- Clinical Examination: Assessment of hip pain, range of motion, and gait.
- Imaging Studies: X-rays or MRI scans are used to visualize the femoral head and assess the extent of flattening and any associated changes in the hip joint.

Treatment

Management of coxa plana may include:
- Conservative Approaches: Physical therapy, pain management, and activity modification to alleviate symptoms.
- Surgical Intervention: In severe cases, surgical options such as osteotomy or hip replacement may be considered to restore function and relieve pain.

Conclusion

ICD-10 code M91.20 for coxa plana, unspecified hip, encapsulates a significant condition that can lead to considerable morbidity if not properly managed. Understanding the clinical implications, potential causes, and treatment options is crucial for healthcare providers in delivering effective care to affected patients. Early diagnosis and intervention can help mitigate the long-term effects of this condition, improving patient outcomes and quality of life.

Coxa plana, also known as Perthes disease, is a condition characterized by avascular necrosis of the femoral head, leading to flattening of the hip joint. The ICD-10 code M91.20 specifically refers to coxa plana of the hip that is unspecified, indicating that the diagnosis does not specify the severity or stage of the condition. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Coxa plana typically presents in children, particularly between the ages of 4 and 8 years, although it can occur in older children and adolescents. The condition is more common in boys than girls, with a ratio of approximately 4:1. The clinical presentation may vary based on the stage of the disease and the individual patient.

Signs and Symptoms

1. Hip Pain:
   - Patients often report pain in the hip, groin, or thigh, which may be exacerbated by activity and relieved by rest. The pain can be dull or sharp and may radiate to the knee.

2. Limping:
   - A noticeable limp is common, particularly during walking or running. This is often due to pain or mechanical instability in the hip joint.

3. Limited Range of Motion:
   - There may be a reduction in the range of motion of the hip joint, particularly in internal rotation and abduction. This limitation can be assessed during a physical examination.

4. Muscle Atrophy:
   - Over time, disuse of the affected leg may lead to muscle atrophy, particularly in the thigh and hip region.

5. Joint Stiffness:
   - Patients may experience stiffness in the hip joint, especially after periods of inactivity.

6. Symptoms of Inflammation:
   - In some cases, there may be signs of inflammation, such as swelling or warmth around the hip joint, although this is less common.

Patient Characteristics

• Age:

• Most commonly affects children aged 4 to 8 years, but can occur in older children and adolescents.

• Gender:

• More prevalent in males, with a higher incidence compared to females.

• Family History:

• A family history of Perthes disease may increase the likelihood of developing coxa plana.

• Ethnicity:

• Some studies suggest variations in incidence among different ethnic groups, although the reasons for this are not fully understood.

• Activity Level:

• Active children may present with more pronounced symptoms due to increased stress on the hip joint.

Conclusion

Coxa plana (ICD-10 code M91.20) is a significant pediatric condition that requires early diagnosis and management to prevent long-term complications such as osteoarthritis or hip deformity. The clinical presentation typically includes hip pain, limping, and limited range of motion, primarily affecting young boys. Early intervention, including physical therapy and, in some cases, surgical options, can help manage symptoms and improve outcomes for affected children. Regular follow-up is essential to monitor the progression of the disease and adjust treatment as necessary.

Coxa plana, classified under ICD-10 code M91.20, refers to a condition characterized by flattening of the femoral head, which can lead to hip joint dysfunction. This condition is often associated with Perthes disease, a childhood hip disorder that affects blood supply to the femoral head, resulting in bone death and subsequent deformity.

Alternative Names for Coxa Plana

1. Legg-Calvé-Perthes Disease: This is the most common alternative name associated with coxa plana, particularly when the condition is due to avascular necrosis of the femoral head in children.
2. Avascular Necrosis of the Femoral Head: This term describes the underlying pathology that can lead to coxa plana, where the bone tissue dies due to a lack of blood supply.
3. Flat Hip: A more colloquial term that may be used to describe the condition in layman's terms.

Related Terms

1. Perthes Disease: Specifically refers to the condition in children that leads to coxa plana, characterized by the same flattening of the femoral head.
2. Hip Dysplasia: While not synonymous, this term relates to developmental issues in the hip joint that can lead to similar symptoms or complications.
3. Coxa Vara: This term refers to a different deformity of the hip where the angle between the femoral neck and shaft is decreased, but it is often discussed in conjunction with coxa plana due to their related nature in hip deformities.
4. Osteonecrosis: A broader term that encompasses conditions like coxa plana, where bone tissue dies due to insufficient blood supply.

Conclusion

Understanding the alternative names and related terms for ICD-10 code M91.20 is crucial for accurate diagnosis and treatment planning. These terms not only help in clinical settings but also enhance communication among healthcare professionals regarding the condition and its implications. If you need further information on treatment options or management strategies for coxa plana, feel free to ask!

Coxa plana, also known as Perthes disease, is a condition characterized by avascular necrosis of the femoral head, leading to flattening of the hip joint. The ICD-10 code M91.20 specifically refers to "Coxa plana, unspecified hip." To diagnose this condition, healthcare professionals typically rely on a combination of clinical evaluation, imaging studies, and specific diagnostic criteria.

Diagnostic Criteria for Coxa Plana (ICD-10 Code M91.20)

1. Clinical Evaluation

• Symptoms: Patients often present with hip pain, limping, and reduced range of motion. Symptoms may vary in intensity and can be exacerbated by physical activity.
• Age Group: Coxa plana primarily affects children, typically between the ages of 4 and 8 years, although it can occur in older children and adolescents.

2. Physical Examination

• Gait Analysis: Observing the patient's gait can reveal limping or a trendelenburg gait, which indicates weakness in the hip abductor muscles.
• Range of Motion: Limited internal rotation and abduction of the hip joint may be noted during the examination.

3. Imaging Studies

• X-rays: Initial imaging often includes X-rays of the hip joint, which can show changes in the shape of the femoral head, joint space narrowing, and other signs of avascular necrosis.
• MRI: Magnetic Resonance Imaging (MRI) may be utilized for a more detailed assessment, particularly to evaluate the extent of bone necrosis and to rule out other conditions.
• CT Scans: In some cases, a CT scan may be performed to provide a clearer view of the bone structure and any deformities.

4. Differential Diagnosis

• It is crucial to differentiate coxa plana from other hip disorders, such as septic arthritis, osteomyelitis, or developmental dysplasia of the hip. This may involve additional tests or imaging studies to confirm the diagnosis.

5. Laboratory Tests

• While laboratory tests are not typically definitive for coxa plana, they may be used to rule out other conditions. For instance, inflammatory markers can help assess for infection or inflammatory diseases.

6. ICD-10 Coding Considerations

• The unspecified nature of the M91.20 code indicates that the diagnosis has been made without specifying the laterality (right or left hip) or any additional details regarding the severity or specific characteristics of the condition.

Conclusion

Diagnosing coxa plana (ICD-10 code M91.20) involves a comprehensive approach that includes clinical assessment, physical examination, and imaging studies. The combination of these elements helps healthcare providers confirm the diagnosis and differentiate it from other potential hip disorders. Early diagnosis and intervention are crucial to managing the condition effectively and preventing long-term complications. If you have further questions or need more specific information, feel free to ask!

Coxa plana, also known as Perthes disease, is a condition characterized by avascular necrosis of the femoral head, primarily affecting children. The ICD-10 code M91.20 specifically refers to coxa plana of the hip that is unspecified. Treatment approaches for this condition can vary based on the severity of the disease, the age of the patient, and the extent of hip involvement. Below is a detailed overview of standard treatment approaches for coxa plana.

Overview of Coxa Plana

Coxa plana typically occurs in children aged 4 to 8 years and is characterized by a temporary loss of blood supply to the femoral head, leading to bone death and subsequent deformity. The condition can result in 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 Monitoring

In mild cases, especially in younger children, a conservative approach may be adopted. This involves:

• Regular Follow-ups: Monitoring the condition through periodic physical examinations and imaging studies (like X-rays) to assess the progression of the disease.
• Activity Modification: Advising the child to avoid high-impact activities that could exacerbate symptoms.

2. Physical Therapy

Physical therapy plays a vital role in the management of coxa plana. Key components include:

• Strengthening Exercises: Focused on the hip and surrounding muscles to improve stability and support.
• 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 Position: Devices like abduction braces can help keep the hip in a proper position, reducing stress on the femoral head.
• Limit Weight Bearing: Crutches or a wheelchair may be used to minimize weight on the affected leg during the healing process.

4. Medications

Pain management is an essential aspect of treatment. 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 acute episodes.

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-Treatment Rehabilitation

After any surgical intervention, a structured rehabilitation program is essential to:

• Restore Function: Focus on regaining strength, flexibility, and range of motion.
• Prevent Complications: Address any potential issues that may arise post-surgery, such as stiffness or weakness.

Conclusion

The management of coxa plana (ICD-10 code M91.20) is multifaceted and tailored to the individual needs of the child. Early diagnosis and a combination of conservative and, if necessary, surgical treatments can lead to favorable outcomes. Continuous monitoring and rehabilitation are crucial to ensure optimal recovery and function of the hip joint. If you suspect coxa plana in a child, it is essential to consult a healthcare professional for a comprehensive evaluation and personalized treatment plan.