ICD-10: M93.023

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.023, 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 categorized as "nontraumatic," indicating that it typically arises without a specific injury or trauma, and is often associated with gradual onset rather than an acute event.

Clinical Description

Definition and Pathophysiology

Chronic slipped upper femoral epiphysis occurs when the femoral head, which is the ball at the top of the thigh bone, slips off the neck of the femur due to weakness in the growth plate. This slippage can lead to a range of symptoms, including hip pain, limited range of motion, and a noticeable limp. The condition is termed "chronic" when the slippage has been present for an extended period, often leading to more significant deformity and complications if left untreated.

Symptoms

Patients with chronic SUFE may present with:
- Hip or groin pain: This pain can be persistent and may worsen with activity.
- Limited range of motion: Particularly in internal rotation of the hip.
- Limping: Affected individuals may exhibit a limp, which can be more pronounced during physical activity.
- Leg length discrepancy: In some cases, the affected leg may appear shorter than the other.

Diagnosis

Diagnosis typically involves a combination of clinical evaluation and imaging studies. Key diagnostic steps include:
- Physical Examination: Assessment of hip range of motion and pain response.
- Imaging: X-rays are the primary tool for diagnosis, revealing the degree of slippage and any associated deformities. In some cases, MRI may be used to assess the condition of the cartilage and surrounding structures.

Treatment Options

Management of chronic SUFE focuses on stabilizing the femoral head and preventing further slippage. Treatment options may include:
- Surgical Intervention: The most common approach is surgical fixation of the femoral head using screws or pins to prevent further displacement. This is often indicated in cases where the slippage is significant or symptomatic.
- Non-Surgical Management: In mild cases, particularly if the patient is asymptomatic, careful monitoring may be considered. However, this approach is less common for chronic cases.

Prognosis

The prognosis for individuals with chronic SUFE largely depends on the timing of diagnosis and intervention. Early detection and appropriate management can lead to favorable outcomes, including the preservation of hip function and reduction of long-term complications such as osteoarthritis.

Conclusion

Chronic slipped upper femoral epiphysis (ICD-10 code M93.023) is a significant orthopedic condition that requires careful clinical assessment and timely intervention. Understanding the clinical presentation, diagnostic criteria, and treatment options is crucial for healthcare providers to ensure optimal patient outcomes. Regular follow-up and monitoring are essential to manage any potential complications associated with this condition.

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.023, is a condition primarily affecting adolescents and is characterized by a 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 Mechanism

Chronic slipped upper femoral epiphysis occurs when the femoral head slips posteriorly and inferiorly relative to the femoral neck. This condition is termed "chronic" when the slippage develops gradually over time, often leading to a stable presentation where the displacement does not progress rapidly. The "nontraumatic" designation indicates that the condition arises without a specific traumatic event, often linked to hormonal changes and mechanical stress during periods of rapid growth in adolescents.

Patient Characteristics

• 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 to 3:1.
• Obesity: Higher incidence in overweight or obese individuals, likely due to increased mechanical stress on the hip joint.
• Ethnicity: Some studies suggest variations in prevalence among different ethnic groups, with higher rates observed in certain populations.

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 intermittent and may worsen with activity.
• Limited Range of Motion: There may be a noticeable decrease in the range of motion of the hip joint, particularly in internal rotation and abduction.
• Limping: Affected individuals may present with a limp, which can be attributed to pain or mechanical instability in the hip joint.
• Leg Discrepancy: In some cases, there may be a noticeable difference in leg length due to the position of the femoral head.

Physical Examination Findings

• Tenderness: Palpation of the hip may reveal tenderness over the femoral head or groin area.
• 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 limitations in other movements.
• Positioning: Patients may adopt a position of external rotation of the affected leg, which can be observed during the examination.

Diagnosis and Imaging

Diagnosis is typically confirmed through imaging studies, including:
- X-rays: Anteroposterior and lateral views of the hip can reveal the characteristic slippage of the femoral head.
- MRI: In some cases, MRI may be utilized to assess the degree of slippage and to evaluate any associated changes in the surrounding soft tissues.

Conclusion

Chronic slipped upper femoral epiphysis (ICD-10 code M93.023) is a significant condition in pediatric orthopedics that requires timely diagnosis and management to prevent complications such as avascular necrosis or osteoarthritis. Awareness of the clinical presentation, signs, symptoms, and patient characteristics is crucial for healthcare providers to ensure appropriate evaluation and treatment. Early intervention can lead to better outcomes and a return to normal activities for affected adolescents.

Chronic slipped upper femoral epiphysis, stable (nontraumatic), unspecified hip, classified under ICD-10 code M93.023, is a specific condition that can be referred to by various alternative names and related terms. Understanding these terms can be beneficial for healthcare professionals, researchers, and students in the medical field.

Alternative Names

1. Chronic Slipped Capital Femoral Epiphysis (SCFE): This term is often used interchangeably with chronic slipped upper femoral epiphysis, as SCFE specifically refers to the same condition affecting the femoral head.

2. Stable Slipped Capital Femoral Epiphysis: This designation emphasizes the stability of the condition, indicating that the femoral head has not significantly displaced.

3. Chronic SCFE: This abbreviation is commonly used in clinical settings to denote the chronic nature of the condition.

4. Nontraumatic Slipped Upper Femoral Epiphysis: This term highlights that the condition is not caused by an acute injury, distinguishing it from traumatic cases.

Related Terms

1. Epiphyseal Displacement: This term refers to the displacement of the epiphysis, which is the end part of a long bone, and is a key feature of the condition.

2. Hip Dysplasia: While not synonymous, hip dysplasia can be related to conditions affecting the hip joint, including SCFE.

3. Femoral Head Deformity: This term describes the potential deformity that can arise from chronic SCFE, affecting the shape and function of the femoral head.

4. Growth Plate Injury: This term encompasses injuries to the growth plate, which can include conditions like SCFE.

5. Pediatric Hip Disorders: This broader category includes various conditions affecting the hip in children, including SCFE.

Conclusion

Understanding the alternative names and related terms for ICD-10 code M93.023 is essential for accurate diagnosis, treatment, and communication among healthcare providers. These terms not only facilitate better understanding of the condition but also enhance the clarity of medical documentation and coding practices. If you have further questions or need more specific information, feel free to ask!

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.023, is a condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate. The diagnosis of this condition involves several criteria, which can be categorized into clinical evaluation, imaging studies, and specific diagnostic criteria.

Clinical Evaluation

1. Patient History:
   - A thorough medical history is essential, focusing on symptoms such as hip or knee pain, limping, and decreased range of motion. Patients may report a gradual onset of symptoms, which is typical for chronic cases[1].

2. Physical Examination:
   - The physical exam should assess for hip range of motion, leg length discrepancies, and any signs of muscle atrophy. Affected individuals may exhibit limited internal rotation of the hip and a positive Trendelenburg sign, indicating weakness in the hip abductors[1].

Imaging Studies

1. X-rays:
   - Anteroposterior (AP) and lateral X-rays of the hip are crucial for visualizing the degree of slippage. The presence of a "slipped" appearance of the femoral head on these images is a key diagnostic feature. The classification of the slippage can be assessed using the Southwick angle or the slip angle[1][2].

2. MRI or CT Scans:
   - In some cases, MRI or CT scans may be utilized to provide a more detailed view of the femoral head and to assess any associated complications, such as avascular necrosis or chondrolysis, which can occur in chronic cases[2].

Diagnostic Criteria

1. Age and Growth Plate Status:
   - Typically, SUFE occurs in adolescents aged 10 to 16 years, during periods of rapid growth. The diagnosis is often confirmed if the patient is within this age range and exhibits signs consistent with slippage at the growth plate[1].

2. Stability Assessment:
   - The condition is classified as stable if the patient can bear weight without significant pain. This is an important distinction, as unstable cases may require more urgent intervention[2].

3. Exclusion of Traumatic Causes:
   - It is essential to rule out any traumatic events that could lead to similar symptoms. The diagnosis of chronic SUFE is specifically for nontraumatic cases, which means that any history of trauma should be carefully evaluated and excluded[1].

Conclusion

The diagnosis of chronic slipped upper femoral epiphysis (ICD-10 code M93.023) involves a comprehensive approach that includes patient history, physical examination, and imaging studies. The criteria focus on identifying the characteristic symptoms, confirming the diagnosis through radiographic evidence, and ensuring that the condition is stable and nontraumatic. Proper diagnosis is crucial for determining the appropriate management and treatment strategies for affected individuals.

Chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.023, 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 children aged 10 to 16 years and is more common in boys than girls. The condition is often associated with obesity and hormonal changes during puberty. Symptoms may include hip pain, limited range of motion, and a limp. Early diagnosis and intervention are crucial to prevent further complications, such as avascular necrosis or osteoarthritis[1].

Non-Surgical Treatment Approaches

Observation and Activity Modification

In cases where the slip is stable and the patient is asymptomatic or has mild symptoms, a conservative approach may be adopted. This 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: Gentle range-of-motion exercises can help maintain joint function without exacerbating the condition. Physical therapy may also focus on strengthening the surrounding musculature to support the hip joint[1].

Pain Management

Pain relief is an essential component of managing chronic SUFE. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly prescribed to alleviate pain and inflammation associated with the condition[1].

Surgical Treatment Approaches

When conservative management is insufficient, or if the slip is significant, surgical intervention is often necessary. The primary surgical options include:

In Situ Fixation

• Procedure: This is the most common surgical treatment for stable chronic SUFE. It involves the insertion of screws or pins to stabilize the femoral head and prevent further slippage. The procedure is typically performed through a small incision and can often be done arthroscopically.
• Indications: In situ fixation is indicated for patients with stable slips who are still growing, as it allows for continued growth of the femoral head while preventing further displacement[1][2].

Osteotomy

• Procedure: 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.
• Indications: Osteotomy is generally reserved for more severe cases or when there is a need to correct associated deformities[2].

Postoperative Care and Rehabilitation

Following surgical intervention, a structured rehabilitation program is essential for optimal recovery. This typically includes:

• Weight-Bearing Protocols: Gradual reintroduction of weight-bearing activities is crucial. Patients may start with partial weight-bearing and progress to full weight-bearing as tolerated.
• Physical Therapy: A tailored physical therapy program focusing on strengthening, flexibility, and functional mobility is vital to restore hip function and prevent complications[1][2].

Conclusion

Chronic slipped upper femoral epiphysis (ICD-10 code M93.023) requires careful management to prevent long-term complications. While non-surgical approaches may be suitable for stable cases, surgical intervention is often necessary for more severe presentations. A multidisciplinary approach involving orthopedic specialists, physical therapists, and primary care providers is essential to ensure comprehensive care and optimal outcomes for affected adolescents. Regular follow-up is also crucial to monitor for any potential complications or the need for further intervention.