ICD-10: M93.011

Acute slipped upper femoral epiphysis (SUFE) is a condition that primarily affects adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate (physis). The ICD-10 code M93.011 specifically refers to a stable, nontraumatic case of this condition affecting the right hip.

Clinical Description

Definition

Acute slipped upper femoral epiphysis is a condition where the femoral head, which is the ball at the top of the thigh bone (femur), slips off the neck of the femur at the growth plate. This slippage can occur suddenly and is often associated with symptoms such as hip pain, limited range of motion, and sometimes referred pain to the knee.

Stability

In the context of M93.011, "stable" indicates that the femoral head remains in a relatively fixed position despite the slippage. This contrasts with "unstable" cases, where the displacement is more severe and can lead to complications such as avascular necrosis of the femoral head.

Etiology

The exact cause of acute slipped upper femoral epiphysis is not fully understood, but it is believed to be related to hormonal changes during puberty, obesity, and mechanical stress on the hip joint. It is more common in boys than girls and typically occurs between the ages of 10 and 16.

Symptoms

Patients with acute SUFE may present with:
- Sudden onset of hip or groin pain
- Pain that may radiate to the knee
- Limping or difficulty walking
- Limited internal rotation of the hip
- Decreased range of motion

Diagnosis

Diagnosis is primarily made through clinical evaluation and imaging studies. X-rays are the standard imaging modality used to confirm the diagnosis, showing the characteristic slippage of the femoral head. MRI may be utilized in certain cases to assess the condition of the femoral head and surrounding structures.

Treatment

The management of stable acute slipped upper femoral epiphysis typically involves:
- Surgical Intervention: The most common treatment is surgical fixation of the femoral head to prevent further slippage and complications. This is usually done using screws or pins.
- Non-Surgical Management: In some cases, particularly if surgery is not immediately feasible, non-weight-bearing measures may be recommended until surgical intervention can be performed.

Prognosis

The prognosis for stable cases of acute slipped upper femoral epiphysis is generally good, especially with timely surgical intervention. However, if left untreated, there is a risk of complications such as avascular necrosis, which can lead to long-term joint problems.

Conclusion

ICD-10 code M93.011 captures the clinical essence of acute slipped upper femoral epiphysis, stable, affecting the right hip. Understanding this condition is crucial for timely diagnosis and management, which can significantly impact the long-term outcomes for affected adolescents. Early recognition and appropriate treatment are key to preventing complications and ensuring optimal recovery.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.011, 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 diagnosed and treated promptly. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Definition and Mechanism

Acute slipped upper femoral epiphysis occurs when the femoral head slips off the neck of the femur at the growth plate (physis) due to mechanical stress or hormonal changes. In the case of M93.011, the slip is classified as stable, meaning that the patient can still bear weight on the affected limb without severe pain or instability.

Patient Demographics

• Age Group: Typically occurs in adolescents aged 10 to 16 years, with a peak incidence around 12 years for girls and 14 years for boys[1].
• Gender: More common in males than females, with a ratio of approximately 2:1[1].
• Obesity: Higher prevalence in overweight or obese adolescents, which may contribute to increased mechanical stress on the hip joint[1].

Signs and Symptoms

Common Symptoms

• Hip Pain: Patients often present with pain in the hip or groin, which may be referred to the knee. The pain can be acute and sudden in onset or may develop gradually over time[1].
• Limited Range of Motion: There may be a noticeable reduction in the range of motion of the hip joint, particularly in internal rotation and abduction[1].
• Limping: Affected individuals often exhibit a limp, which may be due to pain or mechanical instability[1].
• Leg Positioning: The affected leg may appear externally rotated and may be held in a position of flexion and abduction[1].

Physical Examination Findings

• Tenderness: Palpation of the hip joint may reveal tenderness over the femoral head and neck region[1].
• Decreased Mobility: The clinician may observe decreased mobility during the physical examination, particularly in movements that require internal rotation[1].
• Muscle Spasms: In some cases, muscle spasms around the hip may be present, contributing to discomfort and limited movement[1].

Diagnostic Considerations

Imaging Studies

• X-rays: Anteroposterior (AP) and lateral views of the hip are essential for diagnosis. X-rays may show the characteristic slippage of the femoral head[1].
• MRI: In cases where X-rays are inconclusive, MRI may be utilized to assess the extent of the slippage and to evaluate any associated bone marrow edema[1].

Differential Diagnosis

• Transient Synovitis: This condition can mimic SUFE but typically presents with less severe symptoms and a more favorable prognosis[1].
• Osteomyelitis: Infection of the bone may present similarly but is usually accompanied by systemic signs of infection[1].

Conclusion

Acute slipped upper femoral epiphysis, particularly the stable variant coded as M93.011, is a significant condition in adolescent orthopedics. Early recognition of the clinical signs and symptoms, along with appropriate imaging, is crucial for effective management and to prevent complications such as avascular necrosis of the femoral head. Given the demographic trends, awareness among healthcare providers regarding the risk factors, particularly obesity and age, is essential for timely diagnosis and intervention.

Acute slipped upper femoral epiphysis (SUFE) is a condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate. The ICD-10 code M93.011 specifically refers to this condition when it is stable and occurs in the right hip. Here are some alternative names and related terms associated with this diagnosis:

Alternative Names

1. Stable Slipped Capital Femoral Epiphysis (SCFE): This term is often used interchangeably with acute slipped upper femoral epiphysis, particularly when emphasizing the stability of the condition.
2. Right Hip SCFE: A more specific term that indicates the location of the condition.
3. Acute SCFE: This term highlights the acute nature of the condition, distinguishing it from chronic cases.

Related Terms

1. Slipped Capital Femoral Epiphysis (SCFE): A broader term that encompasses both stable and unstable forms of the condition, regardless of the hip involved.
2. Femoral Head Displacement: A general term that describes the movement of the femoral head from its normal position, applicable in various contexts.
3. Growth Plate Injury: While not specific to SCFE, this term relates to injuries affecting the growth plate, which is the site of slippage in this condition.
4. Hip Displacement: A general term that can refer to any displacement of the hip joint, including conditions like SCFE.

Clinical Context

Understanding these terms is crucial for healthcare professionals when diagnosing and coding conditions related to hip disorders in pediatric patients. The distinction between stable and unstable SCFE is particularly important for treatment decisions and prognosis.

In summary, the ICD-10 code M93.011 for acute slipped upper femoral epiphysis, stable (nontraumatic), right hip, is associated with several alternative names and related terms that help clarify the condition's nature and implications in clinical practice.

The diagnosis of ICD-10 code M93.011, which refers to acute slipped upper femoral epiphysis, stable (nontraumatic), right hip, involves several clinical criteria and diagnostic procedures. Here’s a detailed overview of the criteria used for diagnosing this condition:

Clinical Presentation

1. Symptoms: Patients typically present with hip pain, which may be acute or gradual in onset. The pain can be localized to the hip or referred to the knee. Patients may also exhibit a limp or altered gait due to discomfort.

2. Age Group: This condition predominantly affects adolescents, particularly those between the ages of 10 and 16 years. The diagnosis is more common in overweight children and those undergoing rapid growth spurts.

3. Physical Examination: A thorough physical examination is crucial. Key findings may include:
   - Limited internal rotation of the hip.
   - External rotation of the affected leg when the hip is flexed.
   - Tenderness over the hip joint.

Imaging Studies

1. X-rays: The primary diagnostic tool for confirming acute slipped upper femoral epiphysis is radiographic imaging. X-rays of the hip should be performed in multiple views (anterior-posterior and lateral) to assess:
   - The degree of slippage of the femoral head.
   - The presence of any associated abnormalities.

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

Diagnostic Criteria

1. Stable vs. Unstable: The classification of the slip as stable or unstable is critical. A stable slip means that the patient can bear weight on the affected leg without significant pain, while an unstable slip may present with severe pain and inability to bear weight.

2. Nontraumatic Nature: The diagnosis of M93.011 specifically indicates a nontraumatic cause, meaning that the condition arose without a direct injury or trauma. This is often associated with underlying factors such as hormonal changes or mechanical stress.

3. Exclusion of Other Conditions: It is essential to rule out other potential causes of hip pain in adolescents, such as infections, fractures, or other orthopedic conditions, to confirm the diagnosis of acute slipped upper femoral epiphysis.

Conclusion

In summary, the diagnosis of ICD-10 code M93.011 involves a combination of clinical evaluation, imaging studies, and the assessment of the stability of the slip. The condition is characterized by specific symptoms, age-related factors, and the exclusion of other potential diagnoses. Proper identification and management are crucial to prevent complications such as avascular necrosis or further slippage of the femoral head.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.011, 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, focusing on both surgical and non-surgical options.

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 groin pain
- Limited range of motion in the hip
- Limping or altered gait
- Pain that may refer to the knee

Diagnosis

Diagnosis is usually confirmed through clinical evaluation and imaging studies, such as X-rays, which reveal the degree of slippage and any associated complications.

Standard Treatment Approaches

Non-Surgical Management

In cases where the slip is stable and there are no significant complications, non-surgical management may be considered. This approach typically includes:

• Activity Modification: Patients are advised to limit weight-bearing activities to prevent further slippage. Crutches or a wheelchair may be recommended to reduce stress on the hip joint.
• Pain Management: Analgesics such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) can be used to manage pain and inflammation.

However, non-surgical management is generally not the primary treatment for acute SUFE, as the risk of further slippage and complications is significant.

Surgical Intervention

Surgical treatment is the standard approach for acute stable SUFE, aiming to stabilize the femoral head and prevent further displacement. The most common surgical procedures include:

• In Situ Fixation: This is the most frequently performed procedure for stable slips. It involves the insertion of one or more screws through the femoral neck into the femoral head to hold it in place. This method allows for stabilization while preserving the blood supply to the femoral head, which is crucial for its viability.

• Timing of Surgery: Prompt surgical intervention is critical. Ideally, surgery should be performed within days of diagnosis to minimize the risk of complications such as avascular necrosis (loss of blood supply to the femoral head) or chondrolysis (loss of cartilage).

Postoperative Care

Post-surgery, patients typically undergo a rehabilitation program that includes:
- Gradual weight-bearing as tolerated
- Physical therapy to restore range of motion and strength
- Regular follow-up appointments to monitor healing and detect any complications early

Conclusion

Acute slipped upper femoral epiphysis is a serious condition that requires timely and appropriate treatment to prevent long-term complications. While non-surgical management may be considered in specific cases, surgical intervention through in situ fixation remains the standard approach for stabilizing the hip joint. Early diagnosis and treatment are essential to ensure the best possible outcomes for affected adolescents. Regular follow-up and rehabilitation are crucial components of the recovery process, helping to restore function and mobility.