ICD-10: M93.04

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.044, is a significant orthopedic condition primarily affecting adolescents. This condition involves the displacement of the femoral head due to slippage at the growth plate (physis), which can lead to various complications if not addressed promptly.

Clinical Description

Definition

Acute slipped upper femoral epiphysis is characterized by the sudden displacement of the femoral head from its normal position on the femoral neck. This condition is categorized as "unstable" when there is a significant risk of further displacement or complications, such as avascular necrosis of the femoral head, which can occur if blood supply is compromised[1].

Etiology

The exact cause of acute SUFE is not fully understood, but it is often associated with factors such as:
- Hormonal changes: Increased levels of growth hormone during puberty may contribute to the condition.
- Obesity: Higher body mass index (BMI) is a known risk factor, as excess weight can place additional stress on the hip joint.
- Genetic predisposition: A family history of hip disorders may increase susceptibility[1][2].

Symptoms

Patients with acute SUFE typically present with:
- Hip pain: Often localized to the groin, thigh, or knee, which may worsen with activity.
- Limited range of motion: Difficulty in internal rotation of the hip is common.
- Limping: Patients may exhibit a limp or altered gait due to pain and instability[1][2].

Diagnosis

Clinical Evaluation

Diagnosis of acute SUFE involves a thorough clinical examination, focusing on:
- History taking: Assessing the onset and nature of symptoms.
- Physical examination: Evaluating hip range of motion and assessing for tenderness or swelling.

Imaging Studies

Radiographic evaluation is crucial for confirming the diagnosis:
- X-rays: Anteroposterior and lateral views of the hip are typically performed to visualize the displacement of the femoral head.
- MRI: In cases where X-rays are inconclusive, MRI may be utilized to assess the extent of slippage and evaluate for associated complications[1][2].

Treatment

Management Strategies

The management of acute SUFE focuses on stabilizing the femoral head and preventing further slippage:
- Surgical intervention: The primary treatment is often surgical fixation using screws to stabilize the femoral head in its proper position. This is crucial in unstable cases to prevent complications such as avascular necrosis.
- Non-surgical management: In some stable cases, non-weight-bearing and close monitoring may be considered, although this is less common in acute presentations[1][2].

Follow-Up Care

Post-operative care includes:
- Physical therapy: Rehabilitation to restore hip function and strength.
- Regular follow-ups: Monitoring for potential complications, including re-displacement or avascular necrosis, is essential for long-term outcomes[1].

Conclusion

Acute slipped upper femoral epiphysis (ICD-10 code M93.044) is a serious condition that requires prompt diagnosis and intervention to prevent long-term complications. Understanding the clinical presentation, diagnostic methods, and treatment options is vital for healthcare providers managing this condition. Early recognition and appropriate management can significantly improve patient outcomes and preserve hip function.

For further information or specific case management, consulting orthopedic specialists is recommended.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.04, 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 treated promptly. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Patient Demographics

• Age Group: 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 to 3:1[1].
• Obesity: Higher incidence in overweight or obese adolescents, which may contribute to the mechanical stress on the hip joint[1].

Symptoms

Patients with acute unstable slipped upper femoral epiphysis often present with the following symptoms:

• Hip Pain: Sudden onset of hip pain, which may be localized or referred to the knee. The pain can be severe and is often exacerbated by movement.
• Limited Range of Motion: Difficulty in moving the hip joint, particularly with internal rotation and abduction. Patients may exhibit a preference for keeping the hip in a flexed position[1].
• Limping: A noticeable limp is common, often described as a "limp of the affected leg" due to pain and mechanical instability[1].
• Swelling and Tenderness: There may be swelling around the hip joint, and tenderness can be elicited upon palpation of the hip area[1].

Signs

Upon physical examination, healthcare providers may observe:

• Decreased Internal Rotation: A significant reduction in the internal rotation of the hip joint compared to the unaffected side[1].
• External Rotation: The affected leg may be externally rotated when the patient is standing or lying down[1].
• Leg Length Discrepancy: In some cases, there may be a perceived shortening of the affected leg due to the displacement of the femoral head[1].

Diagnostic Considerations

Imaging

• X-rays: Standard imaging techniques, such as X-rays, are crucial for diagnosis. They typically reveal the degree of slippage and any associated complications, such as avascular necrosis[1].
• MRI: In cases where X-rays are inconclusive, MRI may be utilized to assess the condition of the femoral head and surrounding tissues[1].

Conclusion

Acute slipped upper femoral epiphysis (ICD-10 code M93.04) is a serious condition that requires prompt recognition and intervention to prevent long-term complications, including avascular necrosis and osteoarthritis. Understanding the clinical presentation, including the characteristic symptoms and signs, is essential for healthcare providers to facilitate timely diagnosis and management. If you suspect a case of SUFE, immediate referral to an orthopedic specialist is recommended for further evaluation and treatment.

Acute slipped upper femoral epiphysis (SUFE) is a condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate. The ICD-10 code M93.04 specifically refers to the acute and unstable form of this condition. Here are some alternative names and related terms associated with this diagnosis:

Alternative Names

1. Acute Slipped Capital Femoral Epiphysis (SCFE): This term is often used interchangeably with slipped upper femoral epiphysis, emphasizing the capital (head) aspect of the femur.
2. Unstable Slipped Upper Femoral Epiphysis: This highlights the instability of the condition, which can lead to more severe complications.
3. Acute SCFE: A shorthand version that is commonly used in clinical settings.

Related Terms

1. Chronic Slipped Upper Femoral Epiphysis: Refers to a more gradual onset of slippage, contrasting with the acute presentation.
2. Nontraumatic Slipped Upper Femoral Epiphysis: Indicates that the condition arises without a specific traumatic event, which is a key aspect of the M93.04 classification.
3. Femoral Head Displacement: A broader term that encompasses any displacement of the femoral head, including conditions like SUFE.
4. Growth Plate Injury: While not specific to SUFE, this term relates to the underlying mechanism of the condition, as it involves the growth plate (physis) of the femur.

Clinical Context

Understanding these terms is crucial for healthcare professionals when diagnosing and coding for this condition. The acute and unstable nature of M93.04 suggests a need for prompt intervention to prevent complications such as avascular necrosis or further displacement of the femoral head[1][2].

In summary, the terminology surrounding acute slipped upper femoral epiphysis is essential for accurate diagnosis and treatment planning, and familiarity with these terms can enhance communication among healthcare providers.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.04, is a condition primarily affecting adolescents, characterized by 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 diagnostic criteria and considerations for M93.04.

Clinical Presentation

Symptoms

Patients with acute slipped upper femoral epiphysis typically present with:
- Hip Pain: Often localized to the groin, thigh, or knee, which may be acute in onset.
- Limited Range of Motion: Particularly in internal rotation and abduction of the hip.
- Limping: Affected individuals may exhibit a limp or altered gait due to pain and mechanical instability.

Physical Examination

During the physical examination, clinicians look for:
- Decreased Internal Rotation: Notable reduction in internal rotation of the hip joint when the hip is flexed.
- Leg Positioning: The affected leg may appear externally rotated and shortened compared to the contralateral leg.

Imaging Studies

X-rays

• Standard Radiographs: Anteroposterior (AP) and lateral views of the hip are essential for visualizing the displacement of the femoral head. The presence of a "slip" can be identified, which is characterized by the posterior and inferior displacement of the femoral head relative to the femoral neck.
• Frog-leg View: This view can provide additional information about the degree of slippage.

MRI

• Magnetic Resonance Imaging: In cases where X-rays are inconclusive, MRI can be utilized to assess the extent of the slippage and to evaluate any associated bone marrow edema or other complications.

Diagnostic Criteria

Inclusion Criteria

To diagnose acute unstable slipped upper femoral epiphysis, the following criteria are typically considered:
1. Age Group: Most commonly occurs in adolescents, typically between ages 10 and 16.
2. Acute Onset: Symptoms should have a sudden onset, differentiating it from chronic cases.
3. Imaging Findings: Confirmation of slippage on X-ray or MRI, with evidence of instability (e.g., significant displacement).
4. Physical Examination Findings: Presence of hip pain, limited range of motion, and characteristic leg positioning.

Exclusion Criteria

• Traumatic Causes: The diagnosis of M93.04 specifically refers to nontraumatic cases; thus, any history of trauma should be ruled out.
• Other Conditions: Conditions that mimic SUFE, such as infections or tumors, should be excluded through appropriate diagnostic workup.

Conclusion

The diagnosis of acute slipped upper femoral epiphysis (ICD-10 code M93.04) relies on a combination of clinical symptoms, physical examination findings, and imaging studies. Early diagnosis is crucial to prevent complications such as avascular necrosis or further slippage, which can lead to long-term joint issues. If you suspect a case of SUFE, prompt referral to an orthopedic specialist is recommended for further evaluation and management.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.04, 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 promptly and appropriately. Here, we will explore the standard treatment approaches for this condition.

Understanding Acute Slipped Upper Femoral Epiphysis

Definition and Causes

Acute slipped upper femoral epiphysis occurs when the femoral head slips off the neck of the femur at the growth plate, often due to hormonal changes, obesity, or mechanical stress. It is categorized as unstable when there is significant displacement, which can lead to avascular necrosis of the femoral head if not managed correctly[1].

Symptoms

Patients typically present with hip pain, limited range of motion, and sometimes knee pain. The onset can be acute, often following a minor injury or even occurring spontaneously[1].

Standard Treatment Approaches

Initial Management

1. Rest and Activity Modification: Patients are advised to limit weight-bearing activities to prevent further displacement and complications. Crutches or a wheelchair may be recommended to assist mobility[1].

2. Pain Management: Analgesics such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to manage pain and inflammation associated with the condition[1].

Surgical Intervention

Surgical treatment is the cornerstone of management for unstable SUFE. The primary goals are to stabilize the femoral head and prevent further slippage. The following surgical options are typically considered:

1. In Situ Fixation: This is the most common surgical approach, where one or more screws are inserted into the femoral head to hold it in place. This procedure is usually performed under general anesthesia and can be done arthroscopically or through an open approach[1].

2. Open Reduction and Internal Fixation (ORIF): In cases where there is significant displacement, an open reduction may be necessary to realign the femoral head before fixation. This approach allows for direct visualization and correction of the slippage[1].

3. Consideration of Avascular Necrosis: If there is concern for avascular necrosis due to the instability, additional procedures may be required, such as osteotomy or vascularized bone grafting, although these are less common[1].

Postoperative Care

Post-surgery, patients typically undergo a rehabilitation program that includes physical therapy to restore range of motion and strength. Weight-bearing is gradually reintroduced based on the surgeon's assessment of stability and healing[1].

Long-term Follow-up

Regular follow-up is essential to monitor for complications such as avascular necrosis, chondrolysis, or recurrence of slippage. Imaging studies, including X-rays or MRI, may be utilized to assess the integrity of the femoral head and the success of the surgical intervention[1].

Conclusion

The management of acute slipped upper femoral epiphysis, particularly in its unstable form, requires a prompt and effective surgical approach to prevent long-term complications. Early diagnosis, appropriate surgical intervention, and diligent postoperative care are critical to ensuring optimal outcomes for affected adolescents. Regular follow-up is essential to monitor recovery and address any potential complications that may arise.