ICD-10: M93.01

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.01, is a condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate (physis). This condition is categorized as "stable" when the displacement does not lead to significant instability of the femoral head within the acetabulum.

Clinical Description

Definition and Pathophysiology

Acute slipped upper femoral epiphysis occurs when the femoral head, which is the ball at the top of the femur (thigh bone), slips off the neck of the femur at the growth plate. This slippage can be attributed to various factors, including hormonal changes, mechanical stress, and obesity, which can weaken the growth plate. In stable cases, the displacement is less severe, allowing for some degree of normal function and mobility, although pain and limited range of motion are common symptoms.

Symptoms

Patients with acute stable SUFE typically present with:
- Hip or groin pain: This pain may be acute and can radiate to the knee.
- Limited range of motion: Particularly in internal rotation and abduction of the hip.
- Limping: A noticeable limp may develop due to pain and discomfort.
- Leg positioning: The affected leg may appear externally rotated.

Diagnosis

Diagnosis of acute stable SUFE involves a combination of clinical evaluation and imaging studies:
- Physical Examination: Assessment of hip range of motion and pain response.
- X-rays: Anteroposterior and lateral views of the hip are crucial for visualizing the degree of slippage and confirming the diagnosis. The presence of a "Klein's line" can help determine the stability of the epiphysis.
- MRI or CT scans: These may be used in complex cases or when further detail is needed regarding the condition of the growth plate.

Treatment

The management of acute stable SUFE typically involves surgical intervention to prevent further slippage and complications such as avascular necrosis of the femoral head. Common treatment options include:
- Screw fixation: A single or multiple screws may be placed to stabilize the femoral head and prevent further displacement.
- Observation: In very mild cases, close monitoring may be considered, although this is less common.

Prognosis

The prognosis for patients with acute stable SUFE is generally favorable, especially with timely intervention. However, complications can arise, including:
- Chronic pain: If not treated appropriately, patients may experience ongoing discomfort.
- Deformity: Long-term slippage can lead to hip deformities and osteoarthritis.

Conclusion

Acute slipped upper femoral epiphysis (ICD-10 code M93.01) is a significant orthopedic condition in adolescents that requires prompt diagnosis and treatment to prevent complications. Understanding the clinical presentation, diagnostic methods, and treatment options is essential for healthcare providers managing this condition. Early intervention can lead to better outcomes and a return to normal activities for affected individuals.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.01, is a condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage of the growth plate (physis). This condition can lead to significant complications if not diagnosed and treated promptly. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Patient Demographics

• Age Group: SUFE typically occurs in adolescents, most commonly between the ages of 10 and 16 years. It is more prevalent in boys than girls, with a ratio of approximately 2:1[1].
• Growth Patterns: The condition is often associated with periods of rapid growth, which can coincide with puberty. Patients may have a history of obesity or be overweight, which is a known risk factor for SUFE[1].

Signs and Symptoms

• Hip Pain: Patients often present with hip pain, which may be acute or gradually worsening. The pain can be localized to the hip or may radiate to the groin, thigh, or knee[1].
• Limited Range of Motion: There is typically a noticeable reduction in the range of motion of the hip joint, particularly in internal rotation. This limitation can be assessed during a physical examination[1].
• Limping: Affected individuals may exhibit a limp, which can be due to pain or mechanical instability in the hip joint[1].
• Positioning: Patients may prefer to keep the affected leg in an externally rotated position, which can be a compensatory mechanism to alleviate discomfort[1].

Additional Clinical Features

• Swelling and Tenderness: There may be mild swelling around the hip joint, and tenderness can be elicited upon palpation of the hip area[1].
• Muscle Spasms: In some cases, muscle spasms around the hip may occur as a response to pain and instability[1].

Diagnostic Considerations

• Imaging: Diagnosis is typically confirmed through imaging studies, such as X-rays, which can reveal the degree of slippage of the femoral head. In some cases, MRI may be utilized to assess the condition further, especially if there is suspicion of associated complications[1].
• Differential Diagnosis: It is essential to differentiate SUFE from other conditions that may present similarly, such as transient synovitis or osteomyelitis, particularly in acute presentations[1].

Conclusion

Acute slipped upper femoral epiphysis (ICD-10 code M93.01) is a significant orthopedic condition in adolescents that requires prompt recognition and management to prevent long-term complications, including avascular necrosis of the femoral head. Understanding the clinical presentation, including the characteristic signs and symptoms, is crucial for healthcare providers to ensure timely intervention. If you suspect a case of SUFE, immediate referral to an orthopedic specialist is recommended for further evaluation and management.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.01, is a condition primarily affecting adolescents, where the upper femoral epiphysis slips from its normal position. This condition can be referred to by several alternative names and related terms, which can help in understanding its clinical context and implications.

Alternative Names

1. Slipped Capital Femoral Epiphysis (SCFE): This is perhaps the most commonly used term and is often used interchangeably with acute slipped upper femoral epiphysis. It emphasizes the involvement of the capital femoral epiphysis, which is the rounded end of the femur that fits into the hip joint.

2. Acute Slipped Upper Femoral Epiphysis: This term highlights the acute nature of the condition, indicating that it has occurred suddenly rather than being a chronic issue.

3. Stable Slipped Upper Femoral Epiphysis: This term is used to describe cases where the epiphysis has slipped but remains in a stable position, meaning that there is no significant displacement that would complicate treatment.

4. Nontraumatic Slipped Upper Femoral Epiphysis: This designation indicates that the condition arises without a direct traumatic event, distinguishing it from cases that may result from injury.

Related Terms

1. Hip Slippage: A more general term that may be used to describe the phenomenon of the femoral head slipping out of its normal alignment.

2. Femoral Head Displacement: This term refers to the movement of the femoral head from its normal position, which is a key characteristic of slipped upper femoral epiphysis.

3. Growth Plate Injury: Since the condition involves the growth plate (physis) of the femur, it may be discussed in the context of growth plate injuries in pediatric patients.

4. Pediatric Hip Disorders: This broader category includes various conditions affecting the hip in children, including slipped upper femoral epiphysis.

5. Endocrine Disorders: In some cases, conditions such as obesity or hormonal imbalances can contribute to the development of slipped upper femoral epiphysis, linking it to broader endocrine issues.

Understanding these alternative names and related terms can aid healthcare professionals in accurately diagnosing and discussing the condition, as well as in coding for billing and insurance purposes. Each term may carry specific implications for treatment and management strategies, particularly in pediatric populations.

The diagnosis of Acute Slipped Upper Femoral Epiphysis (SUFE), classified under ICD-10 code M93.01, involves a combination of clinical evaluation, imaging studies, and specific diagnostic criteria. Here’s a detailed overview of the criteria used for diagnosis:

Clinical Presentation

1. Age and Demographics:
   - SUFE typically occurs in adolescents, particularly between the ages of 10 and 16 years. It is more common in males than females, with a ratio of approximately 2:1[1].

2. Symptoms:
   - Patients often present with hip or knee pain, which may be acute or chronic. The pain is usually localized to the hip but can also be referred to the knee[1].
   - Limited range of motion in the hip joint, particularly internal rotation, is a common finding during the physical examination[1].

3. Physical Examination:
   - A thorough physical examination is essential. Signs may include:

   • Decreased internal rotation of the hip.
   • External rotation of the affected leg when the hip is flexed.
   • Possible limb length discrepancy if the slip is significant[1].

Imaging Studies

1. X-rays:
   - Anteroposterior (AP) and lateral X-rays of the hip are the primary imaging modalities used to confirm the diagnosis. The following features are assessed:

   • Displacement of the femoral head relative to the femoral neck.
   • The degree of slippage can be classified as mild, moderate, or severe based on the amount of displacement[1][2].

2. MRI or CT Scans:
   - In cases where X-rays are inconclusive or to assess the extent of the slip, MRI or CT scans may be utilized. These imaging techniques can provide detailed information about the cartilage and surrounding soft tissues[2].

Diagnostic Criteria

1. Stable vs. Unstable:
   - The classification of the slip as stable or unstable is crucial. A stable slip means that the patient can bear weight on the affected limb, while an unstable slip indicates that weight-bearing is painful or impossible[1][2].

2. Nontraumatic Nature:
   - The diagnosis of M93.01 specifically refers to nontraumatic cases. This means that the slip occurs without a significant traumatic event, distinguishing it from acute traumatic slips[1].

3. Exclusion of Other Conditions:
   - It is important to rule out other potential causes of hip pain in adolescents, such as infections, tumors, or other orthopedic conditions, to confirm the diagnosis of SUFE[2].

Conclusion

The diagnosis of Acute Slipped Upper Femoral Epiphysis (ICD-10 code M93.01) relies on a combination of clinical assessment, imaging studies, and the classification of the slip's stability. Early diagnosis and intervention are critical to prevent complications such as avascular necrosis of the femoral head or chronic pain. If you suspect SUFE in a patient, a prompt referral to an orthopedic specialist is advisable for further evaluation and management.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.01, is a condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate. This condition can lead to significant complications if not treated promptly and appropriately. Here, we will explore the standard treatment approaches for this condition.

Understanding Acute Slipped Upper Femoral Epiphysis

Definition and Symptoms

Acute SUFE occurs when the femoral head slips off the neck of the femur, typically in a posterior and inferior direction. Symptoms often include hip or knee pain, limited range of motion, and a noticeable limp. The condition is usually non-traumatic, often associated with hormonal changes during puberty, obesity, or underlying endocrine disorders[1].

Standard Treatment Approaches

1. Initial Assessment and Diagnosis

Before treatment, a thorough assessment is essential. This includes:
- Clinical Evaluation: A detailed history and physical examination to assess symptoms and mobility.
- Imaging Studies: X-rays are the primary diagnostic tool, revealing the degree of slippage. MRI may be used for further evaluation if necessary[2].

2. Non-Surgical Management

In cases where the slip is stable and the patient is not experiencing severe symptoms, non-surgical management may be considered:
- Activity Modification: Patients are advised to limit weight-bearing activities to prevent further slippage.
- Pain Management: Analgesics or anti-inflammatory medications can help manage pain and discomfort[3].

3. Surgical Intervention

Surgical treatment is often required for stable slips to prevent complications such as avascular necrosis or osteoarthritis. The primary surgical options include:

a. In Situ Fixation

• Procedure: This is the most common surgical approach for stable SUFE. It involves the insertion of one or more screws through the femoral neck into the femoral head to stabilize the epiphysis and prevent further slippage.
• Indications: Recommended for stable slips where the patient is still growing and has not experienced significant displacement[4].

b. Open Reduction and Internal Fixation (ORIF)

• Procedure: In cases where the slip is unstable or there is significant displacement, an open reduction may be necessary. This involves realigning the femoral head and securing it with screws.
• Indications: Typically reserved for unstable slips or when there is a risk of complications from the slip[5].

4. Postoperative Care and Rehabilitation

Post-surgery, a structured rehabilitation program is crucial:
- Physical Therapy: Initiated as soon as tolerated to restore range of motion and strength.
- Follow-Up Imaging: Regular follow-up with X-rays to monitor healing and ensure proper alignment of the femoral head[6].

5. Long-Term Monitoring

Patients require long-term follow-up to monitor for potential complications, including:
- Avascular Necrosis: A serious complication that can occur if blood supply to the femoral head is compromised.
- Osteoarthritis: Increased risk later in life due to altered biomechanics from the slip[7].

Conclusion

The management of acute slipped upper femoral epiphysis involves a combination of careful assessment, potential surgical intervention, and comprehensive postoperative care. Early diagnosis and appropriate treatment are critical to prevent long-term complications and ensure optimal outcomes for affected adolescents. Regular follow-up is essential to monitor recovery and address any arising issues promptly. If you suspect SUFE, it is crucial to consult a healthcare professional for an accurate diagnosis and tailored treatment plan.