ICD-10: M93.034

Acute on chronic slipped upper femoral epiphysis, stable (nontraumatic), bilateral hips

Additional Information

Description

Clinical Description of ICD-10 Code M93.034

ICD-10 Code M93.034 refers to a specific diagnosis of acute on chronic slipped upper femoral epiphysis, characterized as stable and affecting bilateral hips. This condition is a variant of slipped capital femoral epiphysis (SCFE), which is a common hip disorder in adolescents.

Understanding Slipped Capital Femoral Epiphysis (SCFE)

SCFE occurs when the femoral head (the ball at the top of the thigh bone) slips off the neck of the femur due to a weakness in the growth plate (physis). This condition can be classified into two main types:

  1. Acute SCFE: This type occurs suddenly, often following trauma or injury.
  2. Chronic SCFE: This type develops gradually over time, with symptoms that may be subtle and can include hip or knee pain, limping, and decreased range of motion.

In the case of M93.034, the diagnosis indicates that the patient has both acute and chronic components, meaning there has been a recent exacerbation of symptoms on top of a pre-existing chronic condition. The term "stable" suggests that the femoral head is not displaced significantly, which is crucial for treatment decisions.

Clinical Presentation

Patients with acute on chronic SCFE may present with:

  • Pain: Often localized to the hip or groin, which may radiate to the knee.
  • Limping: A noticeable change in gait due to pain or mechanical instability.
  • Limited Range of Motion: Particularly in internal rotation of the hip.
  • Leg Positioning: The affected leg may appear externally rotated.

Diagnosis

Diagnosis typically involves:

  • Clinical Examination: Assessing range of motion, pain response, and gait abnormalities.
  • Imaging Studies: X-rays are the primary tool for diagnosis, revealing the degree of slippage and any changes in the femoral head's position. In some cases, MRI may be used to assess the condition of the cartilage and surrounding structures.

Treatment Options

Management of acute on chronic SCFE, particularly when stable, may include:

  • Observation: In cases where the condition is stable and not causing significant symptoms.
  • Surgical Intervention: Often indicated to prevent further slippage and complications. This may involve pinning the femoral head to stabilize it and prevent further displacement.

Prognosis

The prognosis for patients with M93.034 can vary based on the timing of diagnosis and treatment. Early intervention generally leads to better outcomes, reducing the risk of complications such as avascular necrosis or osteoarthritis later in life.

Conclusion

ICD-10 code M93.034 encapsulates a complex condition that requires careful clinical evaluation and management. Understanding the nuances of acute on chronic slipped upper femoral epiphysis, particularly in a stable state, is essential for healthcare providers to ensure appropriate treatment and optimal patient outcomes. Regular follow-up and monitoring are crucial to address any changes in the patient's condition over time.

Clinical Information

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 (physis). The ICD-10 code M93.034 specifically refers to a stable, nontraumatic presentation of this condition affecting both hips. Understanding the clinical presentation, signs, symptoms, and patient characteristics is crucial for diagnosis and management.

Clinical Presentation

Definition and Mechanism

Acute on chronic slipped upper femoral epiphysis occurs when there is a sudden worsening of a previously stable condition. In stable SUFE, the femoral head remains partially in place, allowing for some degree of hip function, but with a risk of further slippage. This condition is often seen in adolescents during periods of rapid growth, typically between ages 10 and 16, and is more common in males than females[1].

Signs and Symptoms

Patients with acute on chronic SUFE may present with a variety of signs and symptoms, including:

  • Hip Pain: Patients often report pain in the hip or groin area, which may be acute in onset or have a chronic component due to previous slippage.
  • Limited Range of Motion: There may be a noticeable decrease in the range of motion of the hip joint, particularly in internal rotation.
  • Limping or Altered Gait: Patients may exhibit a limp or an altered gait pattern due to pain and instability in the hip joint.
  • Referred Pain: Pain may also be referred to the knee, which can sometimes lead to misdiagnosis[2].
  • Swelling and Tenderness: There may be localized swelling and tenderness around the hip joint, although this is less common in stable cases.

Patient Characteristics

Certain demographic and clinical characteristics are associated with acute on chronic SUFE:

  • Age: Most commonly affects adolescents, particularly those aged 10 to 16 years, coinciding with periods of rapid skeletal growth[3].
  • Sex: Males are more frequently affected than females, with a ratio of approximately 2:1 to 3:1[4].
  • Obesity: There is a notable association between obesity and SUFE, as excess weight can increase stress on the hip joint and contribute to slippage[5].
  • Previous Episodes: Patients may have a history of previous episodes of hip pain or instability, indicating a chronic underlying condition that has now become acute[6].

Diagnosis and Management

Diagnosis typically involves a combination of clinical evaluation and imaging studies. X-rays are the primary imaging modality used to confirm the diagnosis, revealing the degree of slippage and any changes in the femoral head's position. In some cases, MRI may be utilized to assess the condition of the cartilage and surrounding soft tissues.

Management of acute on chronic SUFE often requires surgical intervention, particularly if the condition is stable but symptomatic. Surgical options may include in situ fixation to stabilize the femoral head and prevent further slippage. Early intervention is crucial to prevent complications such as avascular necrosis of the femoral head or osteoarthritis later in life[7].

Conclusion

Acute on chronic slipped upper femoral epiphysis, stable (nontraumatic), bilateral hips, as classified under ICD-10 code M93.034, presents with a distinct set of clinical features. Recognizing the signs and symptoms, along with understanding patient demographics, is essential for timely diagnosis and effective management. Given the potential complications associated with this condition, healthcare providers should maintain a high index of suspicion in at-risk populations, particularly adolescents presenting with hip pain and altered gait.


References

  1. Diseases of the Musculoskeletal System and Connective Tissue.
  2. ICD-10 Coordination and Maintenance Committee Meeting.
  3. ICD-10 International Statistical Classification of Diseases and Related Health Problems.
  4. Quality and Health Outcomes Committee AGENDA.
  5. Health Evidence Review Commission.
  6. ICD-10-AM/ACHI/ACS Eighth Edition Reference to Changes.
  7. ICD-10 Emergency Codes 10/1/2023 - DC Medicaid.

Approximate Synonyms

ICD-10 code M93.034 refers to "Acute on chronic slipped upper femoral epiphysis, stable (nontraumatic), bilateral hips." This condition is a specific type of hip disorder that primarily affects adolescents and is characterized by the displacement of the femoral head due to slippage at the growth plate. Below are alternative names and related terms that can be associated with this condition:

Alternative Names

  1. Bilateral Slipped Capital Femoral Epiphysis (SCFE): This term emphasizes the bilateral nature of the condition and is commonly used in clinical settings.
  2. Bilateral Stable SCFE: This highlights that the condition is stable, meaning there is no acute displacement or instability.
  3. Bilateral Slipped Upper Femoral Epiphysis: A more descriptive term that specifies the anatomical location of the slippage.
  4. Chronic Slipped Capital Femoral Epiphysis: This term can be used when referring to the chronic aspect of the condition, especially when an acute episode occurs on top of a pre-existing chronic condition.
  1. Epiphyseal Slippage: A general term that describes the movement of the epiphysis relative to the femoral neck.
  2. Hip Displacement: A broader term that can encompass various types of hip joint dislocations or slippages.
  3. Growth Plate Injury: Refers to injuries affecting the growth plate, which is relevant in the context of SCFE.
  4. Nontraumatic Hip Disorder: This term indicates that the condition is not caused by an acute injury, which is pertinent to the classification of M93.034.
  5. Adolescent Hip Disorders: A category that includes various hip conditions affecting adolescents, including SCFE.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals when diagnosing and coding for this condition. Accurate terminology ensures proper communication among medical staff and aids in the management and treatment of patients with slipped capital femoral epiphysis.

In summary, M93.034 can be referred to by various names that reflect its clinical characteristics and implications. Familiarity with these terms can enhance clarity in medical documentation and discussions.

Treatment Guidelines

Overview of Acute on Chronic Slipped Upper Femoral Epiphysis (SUFE)

Acute on chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.034, is a condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate. This condition can be stable or unstable, with stable cases allowing for non-surgical management, while unstable cases often require surgical intervention. The bilateral nature of this condition indicates that both hips are affected, which can complicate treatment and recovery.

Standard Treatment Approaches

1. Initial Assessment and Diagnosis

  • Clinical Evaluation: A thorough history and physical examination are essential. Symptoms often include hip pain, limited range of motion, and a limp.
  • Imaging Studies: X-rays are the primary diagnostic tool, revealing the degree of slippage. MRI may be used for further assessment, especially in cases where the diagnosis is uncertain or to evaluate the extent of the condition.

2. Non-Surgical Management

  • Observation: In stable cases, particularly if the slippage is minimal and the patient is asymptomatic, careful monitoring may be appropriate. Regular follow-up with imaging is essential to track any progression of the condition.
  • Activity Modification: Patients are advised to limit weight-bearing activities to reduce stress on the hip joint. Crutches or a wheelchair may be recommended to assist mobility while minimizing pain.
  • Physical Therapy: Gentle range-of-motion exercises can help maintain joint function without exacerbating the condition. A physical therapist can tailor a program to the patient's specific needs.

3. Surgical Intervention

  • Indications for Surgery: Surgery is typically indicated for unstable slips or when conservative management fails. Surgical options include:
    • In Situ Fixation: This is the most common procedure for stable slips. It involves the insertion of screws to stabilize the femoral head and prevent further slippage. This method preserves the blood supply to the femoral head, which is crucial for healing.
    • Osteotomy: In cases of severe slippage or when there is significant deformity, an osteotomy may be performed to realign the femur and improve hip function.
  • Postoperative Care: After surgery, patients usually require a period of non-weight bearing followed by gradual reintroduction of weight-bearing activities. Physical therapy plays a critical role in rehabilitation.

4. Long-term Management and Follow-up

  • Regular Monitoring: Patients should have regular follow-up appointments to monitor hip function and detect any complications early, such as avascular necrosis or osteoarthritis.
  • Lifestyle Modifications: Encouraging a healthy lifestyle, including weight management and low-impact exercises, can help maintain joint health and function.

Conclusion

The management of acute on chronic slipped upper femoral epiphysis, particularly in bilateral cases, requires a comprehensive approach that includes careful assessment, potential non-surgical management, and surgical intervention when necessary. The choice of treatment should be individualized based on the severity of the condition, the patient's symptoms, and their overall health. Regular follow-up is crucial to ensure optimal outcomes and to address any complications that may arise.

Diagnostic Criteria

The diagnosis of ICD-10 code M93.034, which refers to "Acute on chronic slipped upper femoral epiphysis, stable (nontraumatic), bilateral hips," involves a combination of clinical evaluation, imaging studies, and specific diagnostic criteria. Below is a detailed overview of the criteria and considerations used in diagnosing this condition.

Understanding Slipped Capital Femoral Epiphysis (SCFE)

Slipped Capital Femoral Epiphysis (SCFE) 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, and the distinction is crucial for diagnosis and treatment.

Acute vs. Chronic SCFE

  • Acute SCFE: This occurs suddenly, often following a minor trauma, and is characterized by a rapid onset of symptoms.
  • Chronic SCFE: This develops gradually over time, with symptoms that may be intermittent or mild, often leading to a delay in diagnosis.

In the case of M93.034, the diagnosis specifies an "acute on chronic" condition, indicating that a patient with a pre-existing chronic SCFE has experienced an acute exacerbation of symptoms.

Diagnostic Criteria

Clinical Evaluation

  1. History Taking:
    - The clinician will gather a detailed medical history, including any previous episodes of hip pain, limitations in mobility, or trauma.
    - Symptoms may include hip or knee pain, limping, and decreased range of motion.

  2. Physical Examination:
    - Assessment of hip range of motion, particularly internal rotation, which is often limited in SCFE.
    - Evaluation for signs of hip instability or tenderness.

Imaging Studies

  1. X-rays:
    - AP and Lateral Views: X-rays of the pelvis and hips are essential for visualizing the displacement of the femoral head. In SCFE, the femoral head may appear displaced posteriorly and inferiorly.
    - Bilateral Assessment: Since the diagnosis specifies bilateral hips, imaging should confirm the presence of slippage on both sides.

  2. MRI or CT Scans (if necessary):
    - These imaging modalities may be used for further evaluation, especially if the X-ray findings are inconclusive or if there is a need to assess the degree of slippage and any associated complications.

Classification of Stability

  • Stable vs. Unstable:
  • A stable SCFE means that the patient can bear weight on the affected limb without significant pain. This is an important factor in determining the management approach.
  • The stability of the condition is assessed during the clinical evaluation and confirmed through the patient's ability to walk or bear weight.

Conclusion

The diagnosis of ICD-10 code M93.034 involves a comprehensive approach that includes a thorough clinical history, physical examination, and appropriate imaging studies to confirm the presence of acute on chronic slipped upper femoral epiphysis in both hips. The distinction between stable and unstable conditions is critical for determining the appropriate treatment plan. Early diagnosis and intervention are essential to prevent complications such as avascular necrosis or further slippage, which can lead to long-term joint issues.

Related Information

Description

Clinical Information

  • Acute on chronic slipped upper femoral epiphysis occurs
  • Femoral head displacement due to growth plate slippage
  • Typically affects adolescents during periods of rapid growth
  • More common in males than females
  • Common signs and symptoms include hip pain, limited range of motion
  • Limping or altered gait pattern due to pain and instability
  • Referred pain to the knee can occur
  • Localized swelling and tenderness around the hip joint
  • Associated with obesity and previous episodes of hip pain
  • Diagnosis involves clinical evaluation and imaging studies
  • Surgical intervention may be necessary for stable but symptomatic cases

Approximate Synonyms

  • Bilateral Slipped Capital Femoral Epiphysis
  • Bilateral Stable SCFE
  • Bilateral Slipped Upper Femoral Epiphysis
  • Chronic Slipped Capital Femoral Epiphysis
  • Epiphyseal Slippage
  • Hip Displacement
  • Growth Plate Injury
  • Nontraumatic Hip Disorder

Treatment Guidelines

  • Careful history and physical examination
  • X-rays for diagnostic imaging
  • MRI for further assessment if needed
  • Observation in stable cases with minimal slippage
  • Activity modification to reduce weight-bearing
  • Gentle range-of-motion exercises under physical therapy
  • Surgical intervention for unstable slips or failed conservative management
  • In situ fixation for stable slips
  • Osteotomy for severe slippage or deformity
  • Non-weight bearing postoperatively
  • Gradual reintroduction of weight-bearing activities
  • Regular follow-up appointments for monitoring
  • Lifestyle modifications to maintain joint health

Diagnostic Criteria

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