ICD-10: M93.032

Acute on chronic slipped upper femoral epiphysis (SUFE) is a condition characterized by the displacement of the femoral head due to slippage at the growth plate, which can occur acutely on a background of chronic instability. This condition is particularly relevant in pediatric and adolescent populations, and understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for timely diagnosis and management.

Clinical Presentation

Patient Demographics

• Age Group: Typically affects adolescents, particularly those aged between 10 and 16 years. It is more common in boys than girls, with a ratio of approximately 2:1[1].
• Risk Factors: Obesity is a significant risk factor, as increased body weight can place additional stress on the hip joint. Other factors may include hormonal changes and certain endocrine disorders[1].

Symptoms

• Hip Pain: Patients often present with hip pain that may be localized to the groin, thigh, or knee. The pain can be acute or may have a chronic component, especially if there has been a history of previous episodes[1].
• Limited Range of Motion: There is typically a noticeable reduction in the range of motion of the hip joint, particularly in internal rotation and abduction. This limitation can be more pronounced during acute episodes[1].
• Limping: Patients may exhibit a limp or altered gait due to pain and mechanical instability in the hip joint. This can be particularly evident during weight-bearing activities[1].

Signs

• Physical Examination Findings: On examination, the affected hip may show:
• Tenderness over the hip joint.
• Decreased internal rotation compared to the contralateral side.
• Possible external rotation of the hip when the patient is in a supine position[1].
• Leg Position: The affected leg may appear shorter and externally rotated, which can be a key indicator during physical assessment[1].

Diagnosis

• Imaging Studies: Diagnosis is typically confirmed through imaging, such as X-rays, which can reveal the degree of slippage and any associated changes in the femoral head. MRI may be used in certain cases to assess the extent of the condition and to rule out other pathologies[1].

Conclusion

Acute on chronic slipped upper femoral epiphysis (ICD-10 code M93.032) is a significant condition in the pediatric population that requires prompt recognition and management. Understanding the clinical presentation, including the typical symptoms and signs, as well as the patient characteristics, is essential for healthcare providers. Early intervention can help prevent complications such as avascular necrosis of the femoral head and long-term joint dysfunction. If you suspect a case of SUFE, timely referral to an orthopedic specialist is recommended for further evaluation and treatment.

Acute on chronic slipped upper femoral epiphysis (SUFE) is a condition characterized by the displacement of the femoral head due to slippage at the growth plate, which can occur acutely on a background of chronic slippage. The ICD-10 code M93.032 specifically refers to this condition when it is stable and affects the left hip.

Clinical Description

Definition

Slipped upper femoral epiphysis (SUFE) is a common hip disorder in adolescents, where the femoral head slips off the neck of the femur at the growth plate (physis). This condition can be classified as either acute or chronic, depending on the duration and nature of the symptoms. The acute on chronic designation indicates that the patient has a history of chronic slippage that has recently worsened, leading to acute symptoms.

Symptoms

Patients with acute on chronic SUFE may present with:
- Hip Pain: Often localized to the groin or thigh, which may be exacerbated by activity.
- Limited Range of Motion: Particularly in internal rotation and abduction of the hip.
- Limping: Affected individuals may exhibit a limp due to pain or mechanical instability.
- Referred Pain: Pain may also be felt in the knee, which can sometimes mislead diagnosis.

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. MRI may be used for further evaluation, especially in cases where the diagnosis is uncertain or to assess the condition of the cartilage.

Classification

The condition is classified based on stability:
- Stable SUFE: The patient can bear weight without significant pain, and the displacement is not severe.
- Unstable SUFE: The patient experiences significant pain and cannot bear weight, often requiring surgical intervention.

Treatment

Management of acute on chronic SUFE typically involves:
- Non-Surgical Options: In stable cases, treatment may include activity modification, physical therapy, and pain management.
- Surgical Intervention: If the condition is unstable or if there is significant slippage, surgical fixation (e.g., with screws) may be necessary to stabilize the femoral head and prevent further slippage.

Prognosis

The prognosis for patients with stable acute on chronic SUFE is generally favorable, especially with timely diagnosis and appropriate management. However, untreated or poorly managed cases can lead to complications such as avascular necrosis of the femoral head or early osteoarthritis.

In summary, ICD-10 code M93.032 captures the clinical nuances of acute on chronic slipped upper femoral epiphysis in the left hip, emphasizing the importance of accurate diagnosis and tailored treatment strategies to ensure optimal patient outcomes.

The ICD-10 code M93.032 refers specifically to "Acute on 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 condition:

Alternative Names

1. Acute on Chronic SCFE: This term emphasizes the acute exacerbation of a previously chronic condition.
2. Stable Slipped Capital Femoral Epiphysis: This highlights the stability of the epiphysis despite the slippage.
3. Left Hip SCFE: A straightforward reference indicating the affected side of the body.
4. Nontraumatic SCFE: This term specifies that the condition is not due to a traumatic event.

Related Terms

1. Slipped Capital Femoral Epiphysis (SCFE): The broader term encompassing all types of slipped epiphysis, including acute, chronic, and acute on chronic.
2. Femoral Head Displacement: A general term that describes the displacement of the femoral head, which occurs in SCFE.
3. Hip Slippage: A layman's term that may be used to describe the condition.
4. Epiphyseal Displacement: Refers to the movement of the epiphysis relative to the femoral neck.
5. Adolescent Hip Disorder: A category that includes SCFE and other hip-related issues in adolescents.

Clinical Context

Understanding these terms is crucial for healthcare professionals when diagnosing and treating patients with this condition. The terminology can also assist in coding for insurance and medical records, ensuring accurate communication among medical staff.

In summary, M93.032 is associated with several alternative names and related terms that reflect its clinical significance and implications in pediatric orthopedics.

The diagnosis of acute on chronic slipped upper femoral epiphysis (SUFE), specifically for the ICD-10 code M93.032, involves a combination of clinical evaluation, imaging studies, and specific criteria. Here’s a detailed overview of the diagnostic criteria and considerations for this condition.

Understanding Slipped Upper Femoral Epiphysis (SUFE)

Slipped upper femoral epiphysis is a condition that typically occurs in adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate (physis). It can be classified as either acute or chronic, with the acute on chronic variant indicating a recent exacerbation of a previously existing condition.

Clinical Presentation

1. Symptoms: Patients may present with:
   - Hip or groin pain, which may be referred to the knee.
   - Limited range of motion in the hip joint.
   - Limping or altered gait patterns.
   - Symptoms may be acute in nature, occurring suddenly, or chronic, having developed over time.

2. Physical Examination: Key findings may include:
   - Decreased internal rotation of the hip.
   - Possible external rotation of the affected leg.
   - Tenderness over the hip joint.

Diagnostic Imaging

1. X-rays: The primary imaging modality for diagnosing SUFE includes:
   - Anteroposterior (AP) and lateral views of the hip. These images help visualize the degree of slippage and any changes in the femoral head.
   - Classification of slippage: The degree of slippage can be classified as mild, moderate, or severe based on the displacement observed on X-rays.

2. MRI or CT Scans: In some cases, advanced imaging may be utilized to assess:
   - The extent of the slippage.
   - Any associated complications, such as avascular necrosis of the femoral head.

Diagnostic Criteria for M93.032

To diagnose acute on chronic slipped upper femoral epiphysis, stable (nontraumatic), left hip, the following criteria are typically considered:

1. History of Symptoms: Evidence of chronic symptoms (e.g., hip pain) that have worsened acutely.
2. Imaging Findings:
   - Confirmation of slippage on X-ray, with specific attention to the left hip.
   - Stability of the epiphysis, indicating that the displacement is not acute and severe enough to require immediate surgical intervention.
3. Exclusion of Trauma: The diagnosis must be nontraumatic, meaning that there is no recent injury that could account for the acute exacerbation of symptoms.

Conclusion

The diagnosis of acute on chronic slipped upper femoral epiphysis (ICD-10 code M93.032) requires a thorough clinical assessment, careful interpretation of imaging studies, and consideration of the patient's history. Accurate diagnosis is crucial for determining the appropriate management and treatment plan, which may include observation, physical therapy, or surgical intervention depending on the severity and stability of the condition.

Acute on chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.032, 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 Acute on Chronic Slipped Upper Femoral Epiphysis

Definition and Symptoms

Acute on chronic SUFE occurs when a previously stable condition becomes acute, often presenting with sudden pain, limited range of motion, and an inability to bear weight on the affected hip. Patients may also exhibit symptoms such as hip stiffness and a limp, which can be mistaken for other conditions like hip arthritis or muscle strain[1].

Diagnosis

Diagnosis typically involves a thorough clinical examination and imaging studies, such as X-rays or MRI, to assess the degree of slippage and any associated complications. The classification of the condition as "stable" indicates that the patient can still bear weight, albeit with discomfort[1].

Treatment Approaches

Non-Surgical Management

In cases where the condition is stable and the slippage is not severe, non-surgical management may be considered. This approach includes:

• Activity Modification: Patients are advised to limit weight-bearing activities to prevent further slippage and reduce pain. Crutches or a wheelchair may be recommended for mobility.
• Pain Management: Analgesics such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and inflammation.
• Physical Therapy: Once the acute symptoms subside, physical therapy may be introduced to strengthen the hip muscles and improve range of motion, although this is typically more relevant in chronic cases rather than acute presentations[1].

Surgical Intervention

Surgical treatment is often necessary for acute on chronic SUFE, especially if the condition is unstable or if there is significant slippage. The primary surgical options include:

• In Situ Fixation: This is the most common procedure for stable SUFE. It involves the insertion of screws 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 epiphysis is severely displaced, an osteotomy may be performed. This involves cutting and realigning the bone to restore proper anatomy and function.
• Open Reduction: If the epiphysis is displaced and cannot be stabilized through in situ fixation, an open reduction may be necessary. This procedure allows for direct visualization and manipulation of the femoral head to achieve proper alignment before fixation[1][2].

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.
• Physical Therapy: A structured physical therapy program is essential to restore strength and mobility in the hip joint.
• Follow-Up Imaging: Regular follow-up appointments and imaging studies are necessary to monitor the healing process and ensure that the femoral head remains properly aligned[2].

Conclusion

The management of acute on chronic slipped upper femoral epiphysis, particularly in stable cases, requires a careful balance between conservative and surgical approaches. While non-surgical methods may suffice for mild cases, surgical intervention is often necessary to prevent complications and ensure proper hip function. Early diagnosis and treatment are crucial to achieving the best outcomes for affected adolescents. Regular follow-up and rehabilitation play vital roles in the recovery process, helping to restore mobility and prevent future issues.