ICD-10: M93.004

Unspecified slipped upper femoral epiphysis (nontraumatic), bilateral hips, is classified under the ICD-10-CM code M93.004. This condition is a specific type of slipped capital femoral epiphysis (SCFE), which primarily affects adolescents and is characterized by the displacement of the femoral head due to slippage at the growth plate (physis) of the femur.

Clinical Description

Definition

Slipped upper femoral epiphysis (SUFE) occurs when the femoral head, which is the ball at the top of the thigh bone, slips off the neck of the femur at the growth plate. This condition can be classified as traumatic or nontraumatic, with M93.004 specifically indicating a nontraumatic origin. The bilateral aspect signifies that both hips are affected, which can complicate the clinical picture and management.

Epidemiology

SUFE is most commonly seen in adolescents, particularly those aged 10 to 16 years, and is more prevalent in males than females. The condition is often associated with obesity, hormonal changes, and certain endocrine disorders, which can affect bone growth and development.

Symptoms

Patients with M93.004 may present with:
- Hip or groin pain, which may be referred to the knee.
- Limited range of motion in the hip joint.
- A noticeable limp or altered gait.
- Symptoms may develop gradually, making early diagnosis challenging.

Diagnosis

Diagnosis typically involves:
- Clinical Examination: Assessment of hip range of motion and pain.
- Imaging Studies: X-rays are the primary diagnostic tool, revealing the degree of slippage and any associated changes in the femoral head and neck. MRI may be used for further evaluation if necessary.

Treatment

Management of bilateral slipped upper femoral epiphysis often requires surgical intervention to stabilize the femoral head and prevent further slippage. Treatment options may include:
- Screw Fixation: Inserting screws to hold the femoral head in place.
- Observation: In cases of mild slippage without significant symptoms, careful monitoring may be considered.

Complications

If left untreated, SUFE can lead to:
- Avascular necrosis of the femoral head.
- Early onset of osteoarthritis.
- Chronic pain and functional impairment.

Conclusion

ICD-10 code M93.004 represents a significant clinical condition that requires prompt diagnosis and management to prevent long-term complications. Understanding the clinical presentation, diagnostic criteria, and treatment options is essential for healthcare providers dealing with this condition. Early intervention can lead to better outcomes and improved quality of life for affected adolescents.

Unspecified slipped upper femoral epiphysis (nontraumatic), bilateral hips, is classified under ICD-10 code M93.004. This condition primarily affects adolescents and is characterized by a displacement of the femoral head due to slippage at the growth plate (physis). Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for timely diagnosis and management.

Clinical Presentation

Age and Demographics

• Typical Age Range: Slipped upper femoral epiphysis (SUFE) commonly occurs in children and adolescents, typically between the ages of 10 and 16 years. It is more prevalent in males than females, with a ratio of approximately 2:1[1].
• Bilateral Occurrence: While SUFE can occur unilaterally, bilateral involvement is noted in about 20-40% of cases, which can complicate the clinical picture and management[1][2].

Signs and Symptoms

• Hip Pain: Patients often present with hip pain, which may be localized or referred to the knee. The pain can be acute or chronic, and it may worsen with activity[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 be assessed during a physical examination[1].
• Limping: Affected individuals may exhibit a limp, which can be attributed to pain or mechanical instability in the hip joint[2].
• Leg Positioning: The affected leg may appear externally rotated and shortened compared to the contralateral leg, especially in acute cases[1].

Additional Symptoms

• Stiffness: Patients may report stiffness in the hip joint, particularly after periods of inactivity.
• Muscle Atrophy: Over time, muscle atrophy may develop in the thigh due to disuse or altered gait mechanics[2].

Patient Characteristics

Risk Factors

• Obesity: There is a strong association between obesity and the development of SUFE, as excess weight can place additional stress on the hip joint during growth spurts[1].
• Endocrine Disorders: Conditions such as hypothyroidism or growth hormone abnormalities may predispose individuals to SUFE due to altered growth patterns[2].
• Family History: A familial tendency has been observed, suggesting a genetic component to the condition[1].

Comorbidities

• Patients with SUFE may also present with other musculoskeletal issues, including hip dysplasia or previous hip injuries, which can complicate the clinical picture and management strategies[2].

Conclusion

Unspecified slipped upper femoral epiphysis (nontraumatic), bilateral hips, is a significant condition in pediatric orthopedics that requires careful evaluation and management. Early recognition of the clinical signs and symptoms, along with an understanding of patient characteristics and risk factors, is essential for effective treatment. If left untreated, SUFE can lead to serious complications, including avascular necrosis of the femoral head and early osteoarthritis. Therefore, timely intervention is critical to ensure optimal outcomes for affected individuals.

Unspecified slipped upper femoral epiphysis (nontraumatic), bilateral hips, is classified under the ICD-10 code M93.004. This condition is characterized by a displacement of the femoral head due to slippage at the growth plate, typically occurring in adolescents. Here are some alternative names and related terms associated with this diagnosis:

Alternative Names

1. Bilateral Slipped Capital Femoral Epiphysis (SCFE): This term emphasizes the bilateral nature of the condition, indicating that both hips are affected.
2. Bilateral Slipped Upper Femoral Epiphysis: A direct synonym that specifies the location and nature of the epiphyseal slippage.
3. Bilateral Hip Slippage: A more general term that describes the condition without the technical terminology.
4. Bilateral SCFE: An abbreviation commonly used in clinical settings to refer to slipped capital femoral epiphysis.

Related Terms

1. Slipped Capital Femoral Epiphysis (SCFE): The broader term that encompasses all cases of femoral head slippage, whether unilateral or bilateral.
2. Nontraumatic Slipped Upper Femoral Epiphysis: This term specifies that the condition is not due to an acute injury, distinguishing it from traumatic cases.
3. Epiphyseal Displacement: A general term that refers to the displacement of the epiphysis, which can occur in various conditions, including SCFE.
4. Growth Plate Injury: While not specific to SCFE, this term relates to the underlying mechanism of the condition, as it involves the growth plate (physis) of the femur.

Clinical Context

Understanding these terms is crucial for healthcare professionals when diagnosing and discussing treatment options for patients with this condition. The bilateral aspect of M93.004 indicates that both hips are involved, which can influence treatment decisions and prognosis.

In summary, M93.004 is associated with several alternative names and related terms that reflect its clinical significance and the nature of the condition. These terms are essential for accurate communication in medical settings and for ensuring appropriate care for affected individuals.

The diagnosis of unspecified slipped upper femoral epiphysis (nontraumatic), bilateral hips, classified under ICD-10 code M93.004, involves several clinical criteria and considerations. This condition primarily affects adolescents and is characterized by the displacement of the femoral head due to slippage at the growth plate. Here’s a detailed overview of the diagnostic criteria and relevant considerations:

Clinical Presentation

1. Symptoms: Patients typically present with hip or knee pain, which may be referred pain. They might also exhibit a limp or reduced range of motion in the hip joint. Symptoms can be gradual in onset and may vary in intensity.

2. Age Group: The condition is most commonly seen in adolescents, particularly those aged between 10 and 16 years. It is more prevalent in males than females, and obesity is a significant risk factor.

Physical Examination

1. Gait Analysis: A physical examination often reveals an antalgic gait or a trendelenburg gait due to hip instability.

2. Range of Motion: Limited internal rotation of the hip is a common finding. The clinician may assess the range of motion in various positions to identify any restrictions.

3. Leg Position: The affected leg may appear externally rotated and shortened compared to the contralateral leg.

Imaging Studies

1. X-rays: The primary diagnostic tool is radiographic imaging. Anteroposterior (AP) and lateral views of the hip are essential to visualize the displacement of the femoral head. The presence of a "slip" can be identified by the displacement of the femoral head relative to the neck.

2. MRI or CT Scans: In some cases, advanced imaging techniques like MRI or CT scans may be utilized to assess the extent of slippage and to rule out other conditions, especially if the X-ray findings are inconclusive.

Diagnostic Criteria

1. ICD-10 Classification: The specific code M93.004 is used when the condition is bilateral and unspecified, meaning that the exact nature of the slippage (e.g., stable or unstable) is not clearly defined.

2. Exclusion of Traumatic Causes: It is crucial to differentiate this condition from traumatic causes of hip displacement. A thorough history and examination should rule out any recent trauma or injury.

3. Clinical Guidelines: Following established clinical guidelines and criteria for diagnosing slipped capital femoral epiphysis (SCFE) is essential. These guidelines often include a combination of clinical findings, imaging results, and patient history.

Conclusion

In summary, the diagnosis of unspecified slipped upper femoral epiphysis (nontraumatic), bilateral hips (ICD-10 code M93.004) relies on a combination of clinical evaluation, imaging studies, and exclusion of other conditions. Early diagnosis and intervention are critical to prevent complications such as avascular necrosis or further slippage, which can lead to long-term joint issues. If you suspect this condition, it is advisable to consult a healthcare professional for a comprehensive assessment and appropriate management.

Unspecified slipped upper femoral epiphysis (nontraumatic), bilateral hips, is classified under ICD-10 code M93.004. This condition primarily affects adolescents and involves the displacement of the femoral head due to slippage at the growth plate. Understanding the standard treatment approaches for this condition is crucial for effective management and prevention of complications.

Overview of Slipped Capital Femoral Epiphysis (SCFE)

SCFE is characterized by the displacement of the femoral head from the femoral neck, typically occurring during periods of rapid growth. It can be classified as either traumatic or nontraumatic, with the latter being more common in adolescents. The bilateral presentation, as indicated by the ICD-10 code, suggests that both hips are affected, which can complicate treatment and recovery.

Standard Treatment Approaches

1. Initial Assessment and Diagnosis

Before treatment can begin, a thorough assessment is necessary. This typically includes:

• Clinical Evaluation: A detailed history and physical examination to assess symptoms such as hip pain, limited range of motion, and any signs of leg length discrepancy.
• Imaging Studies: X-rays are the primary imaging modality used to confirm the diagnosis and assess the degree of slippage. MRI may be utilized in certain cases to evaluate the condition of the cartilage and surrounding structures.

2. Non-Surgical Management

In cases where the slippage is mild and the patient is not experiencing significant symptoms, non-surgical management may be considered:

• Activity Modification: Patients are advised to limit weight-bearing activities to reduce stress on the hip joint.
• Physical Therapy: A tailored physical therapy program may help maintain hip mobility and strengthen surrounding muscles without exacerbating the condition.

3. Surgical Intervention

Surgical treatment is often necessary, especially in cases of moderate to severe slippage or when the patient is symptomatic. The primary surgical options include:

• In Situ Fixation: This is the most common procedure for SCFE. It involves the insertion of one or more screws to stabilize the femoral head in its proper position. This method is preferred for stable SCFE cases.
• Osteotomy: In more severe cases or when there is significant deformity, an osteotomy may be performed to realign the femur and improve joint function.
• Surgical Timing: The timing of surgery is critical. Early intervention is associated with better outcomes, as delayed treatment can lead to complications such as avascular necrosis or chondrolysis.

4. Postoperative Care and Rehabilitation

Post-surgery, a structured rehabilitation program is essential for recovery:

• Weight-Bearing Protocol: Gradual reintroduction of weight-bearing activities is crucial. Patients may initially use crutches or a walker.
• Physical Therapy: Continued physical therapy focuses on restoring range of motion, strength, and functional mobility.
• Follow-Up Imaging: Regular follow-up appointments and imaging studies are necessary to monitor healing and detect any complications early.

Conclusion

The management of unspecified slipped upper femoral epiphysis (nontraumatic), bilateral hips, involves a comprehensive approach that includes careful assessment, potential non-surgical management, and often surgical intervention. Early diagnosis and treatment are vital to prevent complications and ensure optimal recovery. Ongoing rehabilitation and monitoring are essential components of the treatment plan to facilitate a return to normal activities and minimize the risk of future issues.