ICD-10: M93.022

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.022, is a condition primarily affecting adolescents, characterized by a displacement of the femoral head due to slippage at the growth plate (physis). This condition is particularly noted for its nontraumatic nature, meaning it occurs without a specific injury or trauma.

Clinical Description

Definition

Chronic slipped upper femoral epiphysis is defined as a gradual displacement of the femoral head from its normal position in the acetabulum, which is the socket of the hip joint. This slippage occurs at the growth plate, leading to a stable condition where the displacement does not progress rapidly.

Epidemiology

• Age Group: Typically affects children and 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.
• Risk Factors: Obesity is a significant risk factor, as increased body weight can place additional stress on the hip joint. Hormonal changes during puberty may also contribute to the condition.

Symptoms

Patients with chronic SUFE may present with:
- Hip Pain: Often described as a dull ache in the hip, groin, or knee, which may worsen with activity.
- Limited Range of Motion: Difficulty in moving the hip, particularly with internal rotation.
- Limping: A noticeable limp may develop due to pain and discomfort.
- Leg Positioning: The affected leg may appear externally rotated.

Diagnosis

Diagnosis typically involves:
- Clinical Examination: Assessment of hip range of motion and pain response.
- Imaging Studies: X-rays are the primary diagnostic tool, revealing the degree of slippage. In chronic cases, the displacement may be subtle, requiring careful evaluation.

Classification

Chronic SUFE can be classified based on the degree of slippage:
- Stable: The femoral head remains in a relatively stable position, with no significant displacement.
- Unstable: Characterized by more severe displacement, which may lead to complications such as avascular necrosis.

Treatment

Management of chronic slipped upper femoral epiphysis focuses on preventing further slippage and complications:
- Surgical Intervention: The most common treatment is surgical fixation of the femoral head to the neck using screws or pins. This procedure aims to stabilize the hip and prevent further displacement.
- Non-Surgical Management: In some cases, particularly if the condition is mild and stable, non-surgical approaches such as activity modification and physical therapy may be considered.

Prognosis

The prognosis for patients with chronic SUFE is generally favorable, especially when diagnosed early and treated appropriately. However, complications such as osteoarthritis or avascular necrosis can occur if the condition is not managed effectively.

In summary, ICD-10 code M93.022 refers to chronic slipped upper femoral epiphysis, stable, left hip, a condition that requires careful clinical evaluation and management to ensure optimal outcomes for affected adolescents. Early diagnosis and appropriate treatment are crucial in preventing long-term complications associated with this condition[1][2][3][4].

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.022, 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 managed appropriately. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Definition and Pathophysiology

Chronic slipped upper femoral epiphysis occurs when the femoral head slips posteriorly and inferiorly relative to the femoral neck. This condition is often classified as stable or unstable, with stable cases allowing for weight-bearing without severe pain. The left hip is specifically noted in this case, indicating the affected side.

Age and Demographics

• Typical Age Range: Most commonly occurs in adolescents aged 10 to 16 years.
• Gender: More prevalent in males than females, with a ratio of approximately 2:1 to 3:1.
• Ethnicity: Higher incidence has been observed in certain ethnic groups, including African American and Pacific Islander populations.

Signs and Symptoms

Common Symptoms

1. Hip Pain: Patients often report pain in the hip or groin, which may be referred to the knee. The pain can be chronic and may worsen with activity.
2. Limited Range of Motion: There may be a noticeable decrease in the range of motion, particularly in internal rotation of the hip.
3. Limping: Affected individuals may present with a limp, often described as a trendelenburg gait due to weakness in the hip abductors.
4. Stiffness: Patients may experience stiffness in the hip joint, particularly after periods of inactivity.

Physical Examination Findings

• Tenderness: Palpation of the hip may reveal tenderness over the greater trochanter and the anterior hip joint.
• Decreased Internal Rotation: A significant finding during the physical examination is the limitation of internal rotation compared to the unaffected side.
• Leg Position: The affected leg may appear externally rotated and shortened compared to the opposite leg.

Patient Characteristics

Risk Factors

• Obesity: Increased body mass index (BMI) is a significant risk factor, as excess weight can place additional stress on the hip joint.
• Growth Spurts: The condition often coincides with periods of rapid growth, making it more common during adolescence.
• Family History: A familial predisposition may be present, suggesting a genetic component to the condition.

Associated Conditions

• Endocrine Disorders: Conditions such as hypothyroidism or growth hormone deficiencies may be associated with an increased risk of SUFE.
• Previous Trauma: While the condition is classified as nontraumatic, a history of minor trauma may be reported, although it is not a direct cause.

Conclusion

Chronic slipped upper femoral epiphysis, stable (ICD-10 code M93.022), is a significant orthopedic condition in adolescents that requires careful clinical evaluation and management. Early recognition of symptoms such as hip pain, limited range of motion, and characteristic gait abnormalities is crucial for preventing complications, including avascular necrosis of the femoral head. Understanding the patient demographics, risk factors, and clinical signs can aid healthcare providers in making timely diagnoses and implementing appropriate treatment strategies. Regular follow-up and monitoring are essential to ensure optimal outcomes for affected individuals.

ICD-10 code M93.022 refers specifically to "Chronic slipped upper femoral epiphysis, stable (nontraumatic), left hip." This condition is a type of slipped capital femoral epiphysis (SCFE), which is a common hip disorder in adolescents. Below are 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 M93.022, emphasizing the chronic nature of the condition.
2. Stable SCFE: This highlights that the condition is stable, meaning the femoral head has not completely slipped off the neck of the femur.
3. Chronic Hip Displacement: A more general term that can refer to the chronic displacement of the femoral head.
4. Chronic Slipped Femoral Epiphysis: A variation that omits "upper" but still conveys the same condition.

Related Terms

1. Slipped Capital Femoral Epiphysis (SCFE): The broader category under which M93.022 falls, encompassing both stable and unstable forms.
2. Nontraumatic Hip Disorder: This term indicates that the condition is not caused by an acute injury.
3. Hip Dysplasia: While not synonymous, this term relates to hip joint abnormalities that can occur in conjunction with SCFE.
4. Femoral Head Displacement: A descriptive term that refers to the displacement of the femoral head, relevant in discussions of SCFE.
5. Pediatric Hip Disorders: A broader category that includes various conditions affecting the hip in children and adolescents, including SCFE.

Clinical Context

Chronic slipped upper femoral epiphysis is characterized by a gradual displacement of the femoral head, typically occurring during periods of rapid growth in adolescents. It is crucial for healthcare providers to recognize the stable form of SCFE, as it may require different management strategies compared to unstable cases.

Understanding these alternative names and related terms can aid in effective communication among healthcare professionals and enhance the accuracy of medical documentation and coding practices.

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. The diagnosis of this condition, specifically under the ICD-10 code M93.022 for the left hip, involves several criteria and considerations.

Diagnostic Criteria for Chronic Slipped Upper Femoral Epiphysis (M93.022)

Clinical Presentation

1. Age Group: Typically occurs in children and adolescents, most commonly between the ages of 10 and 16 years. The condition is more prevalent in males than females[1].
2. Symptoms: Patients 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, often described as a "waddling" gait[1][2].

Physical Examination

1. Range of Motion: A physical examination may reveal decreased internal rotation of the hip, which is a hallmark sign of SUFE. External rotation may be more pronounced when the hip is flexed[2].
2. Leg Position: The affected leg may appear shorter and externally rotated compared to the contralateral leg[1].

Imaging Studies

1. X-rays: The primary diagnostic tool is radiographic imaging. X-rays of the hip are essential to confirm the diagnosis. Key findings include:
   - Displacement of the femoral head relative to the femoral neck.
   - The "ice cream cone" appearance on lateral views, indicating slippage[2][3].
   - Assessment of the degree of slippage, which can be classified as mild, moderate, or severe based on the percentage of displacement[3].
2. MRI: In some cases, MRI may be utilized to assess the condition further, especially if there is suspicion of associated complications such as avascular necrosis[1].

Classification

• Stable vs. Unstable: The classification into stable and unstable SUFE is crucial. Stable SUFE is characterized by the ability to bear weight without significant pain, while unstable SUFE presents with severe pain and inability to bear weight[2][3]. The diagnosis of M93.022 specifically refers to the stable variant.

Exclusion of Other Conditions

• It is important to rule out other potential causes of hip pain in adolescents, such as:
• Osteomyelitis
• Perthes disease
• Fractures
• Other hip disorders[1].

Conclusion

The diagnosis of chronic slipped upper femoral epiphysis, stable (ICD-10 code M93.022) for the left hip, relies on a combination of clinical evaluation, imaging studies, and the exclusion of other 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. If you suspect this condition, it is essential to consult a healthcare professional for a comprehensive evaluation and appropriate management.

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.022, 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 in older children and adolescents, often during periods of rapid growth. The condition is classified as stable when the displacement of the femoral head is not severe, allowing for non-emergency management. Symptoms may include hip pain, limited range of motion, and a limp, which can significantly affect the patient's quality of life.

Standard Treatment Approaches

1. Non-Surgical Management

In cases of stable chronic SUFE, non-surgical management may be considered, particularly if the displacement is minimal and the patient is asymptomatic or has mild symptoms. This approach includes:

• Activity Modification: Patients are advised to limit weight-bearing activities to reduce stress on the hip joint. This may involve using crutches or a wheelchair for mobility.
• Physical Therapy: A tailored physical therapy program can help maintain hip function and strength without exacerbating the condition. Exercises may focus on improving range of motion and strengthening surrounding muscles.
• Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) can be prescribed to manage pain and inflammation associated with the condition.

2. Surgical Intervention

Surgical treatment is often indicated for stable chronic SUFE, especially if there is significant slippage or if the patient experiences persistent symptoms. The primary surgical options include:

• In Situ Fixation: This is the most common surgical approach for stable SUFE. The procedure involves the insertion of screws or pins to stabilize the femoral head in its proper position. This method aims to prevent further slippage and allows for continued growth of the femoral head.
• Osteotomy: In cases where there is significant deformity or if the femoral head is not well-positioned, an osteotomy may be performed. This involves cutting and repositioning the femur to improve alignment and joint function.
• Monitoring and Follow-Up: Post-surgery, regular follow-up appointments are crucial to monitor the healing process and ensure that the femoral head remains stable. Imaging studies, such as X-rays, are typically used to assess the position of the femoral head and the integrity of the fixation devices.

3. Long-Term Management and Considerations

• Growth Monitoring: Since SUFE occurs during a critical growth period, ongoing assessment of growth and development is essential. This includes monitoring for any signs of complications, such as avascular necrosis or osteoarthritis, which can arise from untreated or poorly managed cases.
• Patient Education: Educating patients and their families about the condition, treatment options, and the importance of adhering to follow-up care is vital for successful outcomes.

Conclusion

Chronic slipped upper femoral epiphysis, particularly in its stable form, can be effectively managed through a combination of non-surgical and surgical approaches. While non-surgical management may suffice in mild cases, surgical intervention is often necessary to prevent complications and ensure proper hip function. Regular follow-up and monitoring are crucial to achieving the best possible outcomes for patients with this condition. If you suspect SUFE or are experiencing symptoms, consulting with a healthcare professional specializing in pediatric orthopedics is essential for appropriate diagnosis and treatment planning.