ICD-10: M91.22

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-CM code M91.22 specifically refers to coxa plana affecting the left hip. Below is a detailed clinical description and relevant information regarding this diagnosis.

Clinical Description of Coxa Plana

Definition

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

Etiology

The exact cause of coxa plana remains unclear, but it is believed to involve a combination of genetic, environmental, and possibly traumatic factors. The condition is more prevalent in boys than girls and can be associated with other conditions such as developmental dysplasia of the hip.

Symptoms

Patients with coxa plana may present with:
- Hip pain, which can radiate to the knee
- Limping or altered gait
- Limited range of motion in the hip joint
- Muscle atrophy around the hip due to disuse

Diagnosis

Diagnosis is typically made through a combination of clinical evaluation and imaging studies. Key diagnostic tools include:
- X-rays: These can reveal changes in the shape of the femoral head and joint space narrowing.
- MRI: This imaging modality can provide detailed information about the extent of necrosis and help assess the condition of the surrounding soft tissues.

Treatment

Management of coxa plana focuses on preserving hip function and preventing further joint damage. Treatment options may include:
- Observation: In mild cases, especially in younger children, careful monitoring may be sufficient.
- Physical therapy: To maintain hip mobility and strengthen surrounding muscles.
- Bracing: Devices such as abduction braces may be used to keep the hip in a proper position.
- Surgery: In more severe cases, surgical intervention may be necessary to realign the femoral head or to improve blood supply.

ICD-10 Code M91.22 Specifics

Code Structure

• M91: This is the general category for coxa plana.
• M91.22: This specific code denotes coxa plana affecting the left hip.

Clinical Implications

The use of the ICD-10 code M91.22 is crucial for accurate medical billing, coding, and epidemiological tracking. It helps healthcare providers document the specific condition affecting the patient, which is essential for treatment planning and insurance reimbursement.

Prognosis

The prognosis for children with coxa plana varies. Many children experience a good outcome with appropriate management, often regaining full function as they grow. However, some may develop long-term complications, including osteoarthritis in adulthood, particularly if the condition is not adequately treated.

Conclusion

Coxa plana, particularly as denoted by ICD-10 code M91.22 for the left hip, is a significant pediatric condition that requires careful diagnosis and management. Understanding its clinical presentation, diagnostic criteria, and treatment options is essential for healthcare providers to ensure optimal outcomes for affected children. Regular follow-up and monitoring are critical to address any potential complications that may arise during the growth and development of the child.

Coxa plana, classified under ICD-10 code M91.22, refers to a condition characterized by flattening of the femoral head, typically associated with Perthes disease. This condition primarily affects children and can lead to hip joint problems if not addressed. Below are alternative names and related terms associated with this diagnosis.

Alternative Names for Coxa Plana

1. Perthes Disease: This is the most common alternative name, as coxa plana is often a manifestation of Perthes disease, which involves avascular necrosis of the femoral head in children.
2. Legg-Calvé-Perthes Disease: This term is used interchangeably with Perthes disease and emphasizes the three physicians who first described the condition.
3. Avascular Necrosis of the Femoral Head: While this term is broader, it encompasses the underlying pathology that can lead to coxa plana.

Related Terms

1. Hip Dysplasia: Although not synonymous, hip dysplasia can be related as it involves abnormal development of the hip joint, which may lead to conditions like coxa plana.
2. Osteochondritis Dissecans: This condition can also affect the hip joint and may present with similar symptoms, although it is distinct from coxa plana.
3. Coxa Vara: This term refers to a different deformity of the hip where the angle between the femoral neck and shaft is decreased, contrasting with the flattening seen in coxa plana.
4. Femoral Head Deformity: A general term that can describe various conditions affecting the shape and structure of the femoral head, including coxa plana.

Conclusion

Understanding the alternative names and related terms for ICD-10 code M91.22 is crucial for accurate diagnosis and treatment. Recognizing these terms can aid healthcare professionals in communicating effectively about the condition and ensuring appropriate management strategies are employed. 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 of the hip joint. The diagnosis of coxa plana, particularly for the ICD-10 code M91.22 (Coxa plana, left hip), involves several criteria and diagnostic steps.

Diagnostic Criteria for Coxa Plana (ICD-10 M91.22)

1. Clinical Presentation

• Symptoms: Patients typically present with hip pain, limping, and reduced range of motion. Pain may be referred to the knee, which can sometimes complicate the diagnosis.
• Age Group: Coxa plana commonly affects children aged 4 to 8 years, making age a critical factor in diagnosis.

2. Physical Examination

• Range of Motion: A thorough physical examination is essential to assess the range of motion in the hip joint. Limited internal rotation and abduction are often noted.
• Gait Analysis: Observing the child's gait can reveal a limp or altered walking pattern, which is indicative of hip pathology.

3. Imaging Studies

• X-rays: Radiographic imaging is crucial for diagnosis. X-rays of the hip joint can show changes such as:
  • Flattening of the femoral head
  • Increased joint space
  • Subchondral sclerosis
• MRI: In some cases, an MRI may be used to assess the extent of avascular necrosis and to evaluate the condition of the surrounding soft tissues.

4. Differential Diagnosis

• It is important to rule out other conditions that may present similarly, such as:
  • Septic arthritis
  • Osteomyelitis
  • Other forms of hip dysplasia or developmental disorders

5. ICD-10 Coding Guidelines

• The specific ICD-10 code M91.22 is used to classify coxa plana affecting the left hip. Accurate coding requires confirmation of the diagnosis through the aforementioned clinical and imaging criteria.

Conclusion

The diagnosis of coxa plana (ICD-10 M91.22) involves a combination of clinical evaluation, imaging studies, and consideration of the patient's age and symptoms. Early diagnosis and intervention are crucial to prevent long-term complications, such as joint deformity and osteoarthritis. If you suspect coxa plana in a patient, a comprehensive assessment using the outlined criteria is essential for accurate diagnosis and appropriate management.

Coxa plana, also known as Perthes disease, is a condition characterized by avascular necrosis of the femoral head in children, leading to hip joint dysfunction. The ICD-10 code M91.22 specifically refers to coxa plana affecting the left hip. Treatment approaches for this condition vary based on the severity of the disease, the age of the patient, and the extent of hip joint involvement. Below, we explore standard treatment strategies for managing coxa plana.

Treatment Approaches for Coxa Plana

1. Observation and Monitoring

In mild cases, particularly in younger children (typically under 6 years), a conservative approach may be adopted. This involves regular monitoring of the condition through physical examinations and imaging studies to assess the progression of the disease. The goal is to observe the natural healing process, as many children experience resolution of symptoms without intervention.

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 due to pain or limited mobility.

3. Activity Modification

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

4. Bracing and Orthotic Devices

In some cases, the use of a brace or orthotic device may be recommended to help maintain proper hip positioning and reduce stress on the joint. Devices such as a hip abduction brace can help keep the femoral head centered in the acetabulum, promoting better joint development.

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 to manage severe inflammation, although their use is typically limited due to potential side effects.

6. Surgical Interventions

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 bone to improve the alignment of the hip joint and relieve pressure on the femoral head.
- Core Decompression: This technique involves removing a portion of the bone to relieve pressure and promote blood flow to the affected area, which can aid in healing.

7. Postoperative Rehabilitation

If surgery is performed, a structured rehabilitation program is essential to ensure proper recovery. This may include physical therapy, gradual return to activities, and regular follow-up appointments to monitor healing.

Conclusion

The management of coxa plana (ICD-10 code M91.22) is multifaceted, involving 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 child, considering factors such as age, severity of the condition, and overall health. Early diagnosis and appropriate management are crucial for optimizing outcomes and minimizing long-term complications associated with this condition. Regular follow-up with healthcare providers is essential to monitor progress and adjust treatment plans as necessary.

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 M91.22 specifically refers to coxa plana affecting the left hip. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for diagnosis and management.

Clinical Presentation

Coxa plana typically presents in children, most commonly between the ages of 4 and 8 years, although it can occur in older children and adolescents. The condition is more prevalent in boys than girls, with a ratio of approximately 4:1[1].

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 referred to the knee, leading to misdiagnosis[1].

2. Limited Range of Motion:
   - There is often a noticeable 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[1].

3. Limping:
   - Affected children may present with a limp, which can be attributed to pain or mechanical instability in the hip joint. The limp may be more pronounced after physical activity[1].

4. Muscle Atrophy:
   - Over time, muscle atrophy may occur in the affected leg due to disuse, which can further contribute to functional limitations[1].

5. Joint Stiffness:
   - Stiffness in the hip joint can develop, particularly after periods of inactivity, making it difficult for the child to initiate movement[1].

Patient Characteristics

• Age: Most commonly affects children aged 4 to 8 years, but can occur in older children[1].
• Gender: More frequently diagnosed in boys than girls[1].
• Family History: There may be a familial predisposition, as some studies suggest a genetic component to the disease[1].
• Ethnicity: Coxa plana is more prevalent in certain ethnic groups, with variations in incidence reported across different populations[1].

Diagnosis and Management

Diagnosis of coxa plana typically involves a combination of clinical evaluation and imaging studies. X-rays are the primary imaging modality used to assess the degree of femoral head flattening and to rule out other conditions. MRI may be utilized for a more detailed assessment of the bone and surrounding soft tissues[1].

Management strategies can vary based on the severity of the condition and the age of the patient. Treatment options may include:

• Observation: In mild cases, especially in younger children, careful monitoring may be sufficient.
• Physical Therapy: To improve range of motion and strengthen surrounding muscles.
• Surgical Intervention: In more severe cases, surgical options may be considered to restore hip joint function and prevent long-term complications[1].

Conclusion

Coxa plana (ICD-10 code M91.22) is a significant pediatric condition that requires early recognition and appropriate management to prevent long-term complications such as osteoarthritis. Understanding the clinical presentation, signs, symptoms, and patient characteristics is essential for healthcare providers to ensure timely intervention and optimal outcomes for affected children. Regular follow-up and supportive care are crucial in managing this condition effectively.