ICD-10: M91.21

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 for coxa plana of the right hip is M91.21. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for accurate diagnosis and management.

Clinical Presentation

Coxa plana typically presents in children 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 often includes:

• Limping: One of the most common initial signs, often worsening with activity.
• Hip Pain: Patients may report pain in the hip, groin, or knee, which can be intermittent or persistent.
• Limited Range of Motion: Decreased internal rotation and abduction of the hip joint may be observed during physical examination.
• Muscle Atrophy: Over time, there may be noticeable muscle wasting in the thigh due to disuse.

Signs and Symptoms

The signs and symptoms of coxa plana can vary, but they generally include:

• Pain: Often described as a dull ache, which may radiate to the knee or thigh. Pain can be exacerbated by physical activity and relieved by rest.
• Limp: Affected children may exhibit a characteristic limp, often favoring the affected leg.
• Decreased Mobility: Children may avoid activities that require running or jumping due to discomfort.
• Swelling: In some cases, mild swelling around the hip joint may be present.
• Leg Length Discrepancy: As the disease progresses, there may be a noticeable difference in leg length due to changes in the femoral head.

Patient Characteristics

The typical patient profile for coxa plana includes:

• Age: Most commonly diagnosed in children aged 4 to 8 years, with a peak incidence around 6 years.
• Gender: Predominantly affects boys, with a higher incidence compared to girls.
• Family History: There may be a familial predisposition, as some studies suggest a genetic component to the disease.
• Ethnicity: While coxa plana can affect children of any ethnicity, it is more frequently reported in Caucasian populations.

Conclusion

Coxa plana (ICD-10 code M91.21) is a significant pediatric condition that requires early recognition and intervention to prevent long-term complications such as hip deformity and osteoarthritis. Clinicians should be vigilant for the classic signs of limping, hip pain, and limited range of motion in young children, particularly boys, presenting with these symptoms. Early diagnosis and appropriate management can lead to favorable outcomes, emphasizing the importance of understanding the clinical presentation and patient characteristics associated with this condition.

The ICD-10 code M91.21 specifically refers to "Coxa plana, right hip," which is a medical term used to describe a condition characterized by flattening of the femoral head, often associated with avascular necrosis or other hip disorders. Understanding alternative names and related terms can be beneficial for healthcare professionals, researchers, and students in the medical field. Below are some alternative names and related terms associated with this condition.

Alternative Names for Coxa Plana

1. Flat Hip Syndrome: This term is sometimes used to describe the condition in layman's terms, emphasizing the flattening aspect of the femoral head.

2. Avascular Necrosis of the Femoral Head: While not synonymous, this term is often related to coxa plana, as avascular necrosis can lead to the flattening of the femoral head.

3. Legg-Calvé-Perthes Disease: This is a specific type of coxa plana that occurs in children, where the blood supply to the femoral head is temporarily disrupted, leading to its flattening.

4. Hip Dysplasia: Although this term generally refers to a different condition, it can sometimes be associated with coxa plana due to the structural abnormalities in the hip joint.

5. Coxa Vara: This term refers to a deformity of the hip where the angle between the femoral neck and shaft is decreased, which can sometimes be confused with coxa plana.

Related Terms

1. ICD-10 Codes: Other related ICD-10 codes may include:
   - M91.20: Coxa plana, unspecified hip.
   - M91.22: Coxa plana, left hip.

2. Diagnostic Imaging Terms: Terms such as "hip X-ray" or "MRI of the hip" are often used in the context of diagnosing coxa plana.

3. Orthopedic Terms: Terms like "hip joint pathology" or "femoral head deformity" are relevant when discussing the implications of coxa plana.

4. Treatment Terms: Related treatment terms include "hip arthroplasty," "physical therapy," and "surgical intervention," which may be necessary depending on the severity of the condition.

5. Epidemiological Terms: Terms such as "pediatric hip disorders" or "avascular necrosis prevalence" can provide context for the occurrence of coxa plana in different populations.

Conclusion

Understanding the alternative names and related terms for ICD-10 code M91.21 is crucial for effective communication in the medical field. These terms not only help in identifying the condition but also in discussing its implications, diagnosis, and treatment options. If you need further information on specific aspects of coxa plana or related conditions, 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 M91.21 specifically refers to coxa plana affecting the right hip. The diagnosis of coxa plana involves several criteria, which can be categorized into clinical evaluation, imaging studies, and exclusion of other conditions.

Clinical Evaluation

1. Patient History:
   - The onset of symptoms typically occurs in children aged 4 to 8 years, although it can occur in older children. A history of hip pain, limping, or decreased range of motion is often reported.
   - Family history of hip disorders may also be relevant.

2. Physical Examination:
   - Assessment of hip range of motion, particularly internal rotation and abduction, which may be limited.
   - Observation of gait abnormalities, such as limping or a trendelenburg gait.
   - Tenderness over the hip joint may be noted during palpation.

Imaging Studies

1. X-rays:
   - Initial imaging often includes anteroposterior (AP) and lateral views of the hip. X-rays may show changes in the shape of the femoral head, including flattening and fragmentation.
   - The presence of joint effusion or increased density of the femoral head may also be observed.

2. MRI or CT Scans:
   - Magnetic Resonance Imaging (MRI) can provide detailed images of the femoral head and surrounding soft tissues, helping to assess the extent of avascular necrosis.
   - CT scans may be used in some cases to evaluate the morphology of the hip joint more precisely.

Exclusion of Other Conditions

1. Differential Diagnosis:
   - It is crucial to rule out other causes of hip pain in children, such as septic arthritis, osteomyelitis, or other forms of hip dysplasia.
   - Conditions like transient synovitis or slipped capital femoral epiphysis (SCFE) should also be considered and excluded through appropriate imaging and clinical assessment.

2. Laboratory Tests:
   - While not routinely necessary for the diagnosis of coxa plana, blood tests may be performed to rule out infections or inflammatory conditions.

Conclusion

The diagnosis of coxa plana (ICD-10 code M91.21) for the right hip is based on a combination of clinical history, physical examination findings, and imaging studies, while ensuring that other potential causes of hip pain are excluded. Early diagnosis and intervention are crucial to prevent long-term complications associated with this condition. 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, leading to flattening and deformity of the hip joint. The ICD-10-CM code M91.21 specifically refers to coxa plana affecting the right hip. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description of Coxa Plana (M91.21)

Definition

Coxa plana is a pediatric orthopedic condition that typically occurs in children aged 4 to 8 years. It involves the interruption of blood supply to the femoral head, resulting in bone death (necrosis) and subsequent flattening of the femoral head. This condition can lead to hip pain, limping, and reduced range of motion.

Etiology

The exact cause of coxa plana remains unclear, but several factors may contribute, including:
- Genetic predisposition: A family history of the condition may increase risk.
- Environmental factors: Some studies suggest that environmental influences may play a role.
- Trauma: Previous injuries to the hip may be associated with the onset of the disease.

Symptoms

Children with coxa plana may present with:
- Hip pain: Often localized to the groin, thigh, or knee.
- Limping: A noticeable limp may develop due to pain or discomfort.
- Limited range of motion: Difficulty in moving the hip joint, particularly in internal rotation and abduction.
- Muscle atrophy: Over time, disuse of the affected leg may lead to muscle wasting.

Diagnosis

Diagnosis of coxa plana typically involves:
- Clinical examination: Assessment of symptoms, physical examination, and observation of gait.
- Imaging studies: X-rays are the primary diagnostic tool, revealing changes in the shape of the femoral head. MRI may be used for more detailed evaluation of the bone and surrounding soft tissues.

Treatment

Management of coxa plana focuses on preserving hip function and minimizing pain. Treatment options may include:
- Observation: In mild cases, monitoring the condition may be sufficient.
- Physical therapy: Exercises to improve range of motion and strengthen hip muscles.
- Bracing: Use of a brace to maintain proper hip positioning and reduce stress on the joint.
- Surgery: In severe cases, surgical intervention may be necessary to correct deformities or improve joint function.

Prognosis

The prognosis for children with coxa plana varies. Many children experience a good outcome with appropriate management, often regaining normal hip function as they grow. However, some may develop long-term complications, such as osteoarthritis, later in life.

Conclusion

ICD-10 code M91.21 is designated for coxa plana affecting the right hip, a condition primarily seen in children that can lead to significant hip joint issues if not properly managed. Early diagnosis and intervention are crucial for optimizing outcomes and ensuring the best possible quality of life for affected individuals. Regular follow-up and monitoring are essential to address any potential complications that may arise as the child matures.

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 M91.21 specifically refers to coxa plana of the right hip. 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.

Treatment Approaches for Coxa Plana

1. Observation and Monitoring

In mild cases, especially in younger children, a conservative approach may be adopted. This involves regular monitoring of the condition through physical examinations and imaging studies. The goal is to observe the natural progression of the disease, as many children experience spontaneous recovery.

2. Physical Therapy

Physical therapy plays a crucial role in the management of coxa plana. 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 normal walking pattern, which may be affected by the condition.

3. Activity Modification

Children with coxa plana are often advised to limit high-impact activities that could exacerbate the condition. This includes avoiding sports or activities that put excessive stress on the hip joint. Instead, low-impact activities such as swimming or cycling may be encouraged.

4. Bracing

In some cases, a brace may be used to help maintain the hip in a proper position. The most common type of brace is the abduction brace, which keeps the hip in a position that promotes healing and reduces stress on the femoral head.

5. Medications

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

6. Surgical Interventions

If conservative treatments fail or if the condition is severe, surgical options may be considered. These can include:
- Osteotomy: This procedure involves cutting and repositioning the bone to improve the alignment of the hip joint and redistribute weight more evenly across the femoral head.
- Core Decompression: This surgery aims to relieve pressure within the femoral head and promote blood flow, which can help in the healing process.

7. Postoperative Rehabilitation

Following any surgical intervention, a structured rehabilitation program is essential. This typically includes:
- Gradual return to weight-bearing activities.
- Continued physical therapy to restore strength and function.
- Regular follow-up appointments to monitor recovery and adjust the rehabilitation plan as needed.

Conclusion

The management of coxa plana (ICD-10 code M91.21) involves a combination of observation, physical therapy, activity modification, and, in some cases, surgical intervention. The choice of treatment is tailored to the individual needs of the patient, taking into account the severity of the condition and the age of the child. Early diagnosis and appropriate management are crucial for optimizing outcomes and minimizing long-term complications associated with this condition. Regular follow-up and monitoring are essential to ensure the best possible recovery trajectory.