ICD-10: M93.021

Chronic slipped upper femoral epiphysis (SUFE), particularly the stable type, is a condition that primarily affects adolescents and is characterized by a displacement of the femoral head due to slippage at the growth plate. This condition is coded as M93.021 in the ICD-10 classification system. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this diagnosis.

Clinical Presentation

Definition and Mechanism

Chronic slipped upper femoral epiphysis occurs when the femoral head slips posteriorly and inferiorly relative to the femoral neck. This condition is often nontraumatic and can develop gradually over time, leading to chronic symptoms. The stable variant indicates that the displacement is not severe enough to cause significant instability in the hip joint.

Patient Demographics

• Age: Typically occurs in adolescents, most commonly between the ages of 10 and 16 years.
• Gender: More prevalent in males than females, with a ratio of approximately 2:1.
• Obesity: Higher incidence in overweight or obese adolescents, which may contribute to the mechanical stress on the hip joint.

Signs and Symptoms

Common Symptoms

• Hip Pain: Patients often report pain in the hip or groin area, which may be referred to the knee. The pain can be chronic and may worsen with activity.
• Limited Range of Motion: There may be a noticeable decrease in the range of motion of the hip, particularly in internal rotation and abduction.
• Limping: Affected individuals may present with a limp, which can be attributed to pain or mechanical instability.
• Leg Positioning: The affected leg may appear externally rotated and may be held in a position of flexion.

Physical Examination Findings

• Tenderness: Palpation of the hip joint may reveal tenderness over the greater trochanter and the anterior hip.
• Decreased Internal Rotation: A significant finding during the physical examination is the limitation of internal rotation of the hip, which is often more pronounced than in the unaffected hip.
• Gait Analysis: Observations may reveal an antalgic gait due to pain or mechanical dysfunction.

Diagnostic Imaging

• X-rays: Standard radiographs are crucial for diagnosis, showing the characteristic slippage of the femoral head. The displacement can be assessed using the Southwick angle or the slip angle.
• MRI: In some cases, MRI may be utilized to evaluate the extent of the slippage and to assess for any associated complications, such as avascular necrosis.

Conclusion

Chronic slipped upper femoral epiphysis, stable (ICD-10 code M93.021), is a significant condition in pediatric orthopedics that requires careful evaluation and management. Understanding the clinical presentation, including the typical signs and symptoms, as well as the demographic characteristics of affected patients, is essential for timely diagnosis and intervention. Early recognition and treatment are crucial to prevent complications such as avascular necrosis or further slippage, which can lead to long-term hip dysfunction.

Chronic slipped upper femoral epiphysis (SUFE) is a condition that primarily affects adolescents and involves the displacement of the femoral head due to slippage at the growth plate. The ICD-10 code M93.021 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. Chronic Slipped Capital Femoral Epiphysis (SCFE): This term is often used interchangeably with chronic slipped upper femoral epiphysis, emphasizing the condition's chronic nature.
2. Stable Slipped Capital Femoral Epiphysis: This highlights the stability of the condition, distinguishing it from unstable cases.
3. Chronic Hip Slippage: A more general term that describes the condition without the technical jargon.
4. Upper Femoral Epiphysis Slippage: This term focuses on the anatomical aspect of the condition.

Related Terms

1. Nontraumatic Slipped Capital Femoral Epiphysis: This term indicates that the condition is not caused by an acute injury, which is relevant for coding and diagnosis.
2. Femoral Head Displacement: A broader term that can encompass various conditions affecting the femoral head, including SUFE.
3. Adolescent Hip Disorder: This term can be used to categorize conditions like SUFE that commonly occur during adolescence.
4. Growth Plate Disorder: Since SUFE involves the growth plate, this term can be relevant in a broader context of pediatric orthopedic conditions.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals when diagnosing, coding, and discussing the condition with patients and other providers. Accurate terminology ensures effective communication and appropriate treatment planning.

In summary, the ICD-10 code M93.021 for chronic slipped upper femoral epiphysis, stable (nontraumatic), right hip, is associated with various alternative names and related terms that reflect its clinical characteristics and implications.

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.021, is a condition that primarily affects adolescents and involves the displacement of the femoral head due to slippage at the growth plate. Diagnosing this condition involves a combination of clinical evaluation, imaging studies, and specific criteria. Below is a detailed overview of the criteria used for diagnosis.

Clinical Criteria

1. Patient History:
   - Age: Typically occurs in children and adolescents, most commonly between ages 10 and 16.
   - Symptoms: Patients may present with hip or knee pain, limping, or decreased range of motion. Symptoms can be gradual and may be mistaken for other conditions.

2. Physical Examination:
   - Range of Motion: Limited internal rotation of the hip is often noted during examination.
   - Leg Position: The affected leg may appear externally rotated and shortened compared to the contralateral leg.
   - Tenderness: Palpation may reveal tenderness over the hip joint.

Imaging Studies

1. X-rays:
   - AP and Lateral Views: Standard X-ray imaging of the hip is crucial. The diagnosis is confirmed by observing the displacement of the femoral head relative to the femoral neck.
   - Slippage Assessment: The degree of slippage can be assessed using the Southwick angle or the slip angle, which helps in determining the severity of the condition.

2. MRI or CT Scans (if necessary):
   - These imaging modalities may be used for further evaluation, especially if there is uncertainty in the diagnosis or to assess the extent of the slippage and any associated complications.

Diagnostic Criteria

• Stable vs. Unstable: The classification into stable (nontraumatic) and unstable (traumatic) is based on the degree of displacement and the presence of symptoms. In stable cases, the patient can bear weight with minimal pain, while unstable cases may present with significant pain and inability to bear weight.
• 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.

Conclusion

The diagnosis of chronic slipped upper femoral epiphysis, stable (nontraumatic), right hip (ICD-10 code M93.021) relies on a thorough clinical assessment, detailed patient history, and appropriate imaging studies. The combination of these elements allows healthcare providers to confirm the diagnosis and differentiate it from other similar conditions. Early diagnosis and management are crucial to prevent complications such as avascular necrosis or further slippage, which can lead to long-term joint issues.

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.021, 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 appropriately. Here, we will explore the standard treatment approaches for this condition, focusing on both surgical and non-surgical options.

Understanding Chronic Slipped Upper Femoral Epiphysis

Chronic SUFE typically presents with gradual onset of hip pain, limited range of motion, and sometimes knee pain, which can be misleading. The condition is often diagnosed through clinical evaluation and imaging studies, such as X-rays, which reveal the characteristic slippage of the femoral head[1].

Treatment Approaches

1. Non-Surgical Management

In cases where the slip is stable and the patient is not experiencing significant symptoms, non-surgical management may be considered. This approach includes:

• Activity Modification: Patients are advised to limit weight-bearing activities to reduce stress on the hip joint. This may involve the use of crutches or a wheelchair for mobility[1].
• Physical Therapy: A tailored physical therapy program can help maintain hip function and strengthen surrounding muscles, although it should be approached cautiously to avoid exacerbating the condition[1].

2. Surgical Intervention

Surgical treatment is often necessary for chronic SUFE, especially when the slip is significant or if the patient experiences pain and functional limitations. The primary surgical options include:

• In Situ Fixation: This is the most common surgical procedure for stable slips. It involves the insertion of one or more screws into the femoral head to stabilize the epiphysis and prevent further slippage. This procedure is typically performed arthroscopically or through an open approach, depending on the case[1][2].

• Osteotomy: In cases where there is significant deformity or if the slip is unstable, an osteotomy may be performed. This involves cutting and realigning the femur to restore normal anatomy and function. This option is less common for stable slips but may be necessary in certain complex cases[2].

3. Postoperative Care

Post-surgery, patients typically undergo a rehabilitation program that includes:

• Gradual Weight Bearing: Patients are usually advised to gradually increase weight-bearing activities as tolerated, often starting with partial weight bearing and progressing to full weight bearing over time[1].
• Follow-Up Imaging: Regular follow-up appointments and imaging studies are essential to monitor the healing process and ensure that the femoral head remains stable[2].

Conclusion

The management of chronic slipped upper femoral epiphysis, particularly for stable cases, involves a combination of non-surgical and surgical approaches tailored to the individual patient's needs. While non-surgical management may suffice in mild cases, surgical intervention is often necessary to prevent complications and restore function. Ongoing monitoring and rehabilitation are crucial for optimal recovery and long-term outcomes. If you suspect a case of SUFE, it is essential to consult with a healthcare professional specializing in pediatric orthopedics for a comprehensive evaluation and treatment plan.

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.021, is a condition that primarily affects adolescents and is characterized by a displacement of the femoral head due to slippage at the growth plate (physis). This condition is particularly significant as it can lead to complications if not diagnosed and managed appropriately.

Clinical Description

Definition

Chronic slipped upper femoral epiphysis refers to a gradual displacement of the femoral head in relation to the femoral neck, occurring in a stable manner. This means that the displacement is not acute or traumatic but develops over time, often presenting with mild symptoms that can be overlooked initially. The term "stable" indicates that the femoral head remains in a relatively fixed position, without significant displacement that would lead to acute symptoms or complications.

Epidemiology

This condition is most commonly seen in adolescents, particularly those aged between 10 and 16 years. It is more prevalent in males than females and is often associated with obesity, hormonal changes, and certain endocrine disorders. The right hip is frequently affected, although it can occur bilaterally in some cases.

Symptoms

Patients with chronic SUFE may present with:
- Hip or groin pain, which can be referred to the knee.
- Limited range of motion in the hip joint.
- A limp or altered gait pattern.
- Symptoms that may worsen with activity and improve with rest.

Diagnosis

Diagnosis typically involves a combination of clinical evaluation and imaging studies. Key diagnostic steps include:
- Physical Examination: Assessing hip range of motion and checking for tenderness.
- Imaging: X-rays are the primary tool for diagnosis, revealing the characteristic slippage of the femoral head. In some cases, MRI may be used to assess the condition of the cartilage and surrounding structures.

Treatment

Management of chronic SUFE focuses on preventing further slippage and complications such as avascular necrosis of the femoral head. Treatment options may include:
- Surgical Intervention: The most common approach is the surgical fixation of the femoral head using screws to stabilize the epiphysis.
- Non-Surgical Management: In cases where surgery is not immediately indicated, activity modification and close monitoring may be recommended.

Conclusion

ICD-10 code M93.021 encapsulates the clinical picture of chronic slipped upper femoral epiphysis, stable, affecting the right hip. Early recognition and appropriate management are crucial to prevent long-term complications, including joint degeneration and chronic pain. Regular follow-up and monitoring are essential for patients diagnosed with this condition to ensure optimal outcomes and to address any potential complications that may arise over time.