ICD-10: M93.044

Acute slipped upper femoral epiphysis (SUFE) is a significant orthopedic condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate (physis). The ICD-10 code M93.044 specifically refers to cases that are classified as unstable and bilateral, indicating that both hips are affected and that the condition presents with a higher risk of complications.

Clinical Description

Definition

Acute slipped upper femoral epiphysis is defined as a condition where 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 varying degrees of displacement and is categorized as either stable or unstable. In unstable cases, the displacement is more severe, and the risk of avascular necrosis (loss of blood supply to the bone) is significantly increased[1][2].

Etiology

The exact cause of acute slipped upper femoral epiphysis is not fully understood, but it is believed to be related to a combination of mechanical and hormonal factors. It typically occurs during periods of rapid growth, often seen in children aged 10 to 16 years, and is more prevalent in males than females. Risk factors include obesity, endocrine disorders, and a family history of the condition[3][4].

Symptoms

Patients with M93.044 may present with:
- Sudden onset of hip or groin pain, which may radiate to the knee.
- Limited range of motion in the hip joint.
- Affected limb may appear externally rotated.
- Difficulty bearing weight or walking[5].

Diagnosis

Diagnosis is primarily made through clinical evaluation and imaging studies. X-rays are essential for confirming the diagnosis, showing the degree of slippage and any associated complications. MRI may be used in certain cases to assess the condition of the femoral head and surrounding tissues[6].

Treatment

The management of acute slipped upper femoral epiphysis, particularly in unstable cases, typically involves surgical intervention. The primary goal is to stabilize the femoral head and prevent further slippage. Common surgical procedures include:
- In situ fixation using screws to hold the femoral head in place.
- Osteotomy in severe cases to realign the femur[7].

Postoperative care includes physical therapy and gradual return to weight-bearing activities, with close monitoring for complications such as avascular necrosis or chondrolysis.

Conclusion

ICD-10 code M93.044 captures the critical aspects of acute slipped upper femoral epiphysis, unstable, bilateral hips. This condition requires prompt diagnosis and intervention to prevent long-term complications and ensure optimal outcomes for affected adolescents. Understanding the clinical presentation, diagnostic criteria, and treatment options is essential for healthcare providers managing this orthopedic emergency.

For further information on coding and billing related to this condition, healthcare professionals can refer to the latest ICD-10-CM guidelines and updates[8][9].

Acute slipped upper femoral epiphysis (SUFE), particularly in its unstable form, is a significant orthopedic condition primarily affecting adolescents. The ICD-10 code M93.044 specifically refers to this condition when it occurs bilaterally and is classified as nontraumatic. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for timely diagnosis and management.

Clinical Presentation

Definition and Pathophysiology

Acute slipped upper femoral epiphysis is characterized by the displacement of the femoral head due to slippage at the growth plate (physis). In the unstable variant, this slippage is more pronounced and can lead to significant complications if not addressed promptly. The condition typically occurs during periods of rapid growth, often between the ages of 10 and 16 years, and is more common in males than females[1].

Signs and Symptoms

Patients with unstable acute slipped upper femoral epiphysis may present with a variety of signs and symptoms, including:

• Hip Pain: Patients often report sudden onset of hip pain, which may be localized to the groin or referred to the knee. The pain can be severe and is typically exacerbated by movement[1].
• Limited Range of Motion: There is often a noticeable reduction in the range of motion of the hip joint, particularly in internal rotation and abduction. This limitation can be assessed during a physical examination[1][2].
• Limping: Affected individuals frequently exhibit a limp, which may be due to pain or mechanical instability in the hip joint[2].
• Leg Positioning: The affected leg may appear externally rotated and shortened compared to the contralateral leg, which can be a key indicator during physical examination[1][2].

Additional Symptoms

• Swelling and Tenderness: There may be localized swelling and tenderness around the hip joint, although this is less common in the acute phase compared to chronic cases[1].
• Muscle Spasms: Patients may experience muscle spasms around the hip due to pain and instability[2].

Patient Characteristics

Demographics

• Age: The condition predominantly affects adolescents, typically between the ages of 10 and 16 years, coinciding with periods of rapid skeletal growth[1].
• Gender: Males are more frequently affected than females, with a reported ratio of approximately 2:1[1][2].
• Obesity: There is a notable association between obesity and the incidence of slipped capital femoral epiphysis (SCFE), as excess weight can increase stress on the hip joint during growth spurts[2].

Risk Factors

• Endocrine Disorders: Conditions such as hypothyroidism or growth hormone abnormalities may predispose individuals to SUFE[1].
• Genetic Factors: A family history of hip disorders can increase the risk of developing this condition[2].
• Physical Activity: While not directly causing SUFE, certain high-impact activities may exacerbate symptoms in predisposed individuals[1].

Conclusion

Acute slipped upper femoral epiphysis, particularly in its unstable bilateral form, presents with distinct clinical features that require careful evaluation. Early recognition of symptoms such as hip pain, limited range of motion, and characteristic leg positioning is essential for effective management. Understanding the demographics and risk factors associated with this condition can aid healthcare providers in identifying at-risk patients and implementing timely interventions to prevent complications. If you suspect a case of SUFE, prompt referral to an orthopedic specialist is recommended for further assessment and management.

Acute slipped upper femoral epiphysis (SUFE) is a condition that primarily affects adolescents and involves the displacement of the femoral head due to slippage at the growth plate. The ICD-10 code M93.044 specifically refers to the unstable, nontraumatic form of this condition affecting both hips. Below are alternative names and related terms associated with this diagnosis.

Alternative Names

1. Slipped Capital Femoral Epiphysis (SCFE): This is a more commonly used term that refers to the same condition, emphasizing the slippage of the capital femoral epiphysis.
2. Bilateral Slipped Upper Femoral Epiphysis: This term highlights that the condition affects both hips.
3. Bilateral SCFE: A shorthand version of the above, often used in clinical settings.
4. Acute Bilateral SCFE: This term specifies the acute nature of the condition while indicating that both hips are involved.

Related Terms

1. Unstable Slipped Capital Femoral Epiphysis: This term indicates the severity of the condition, where "unstable" suggests a higher risk of complications.
2. Nontraumatic Slipped Upper Femoral Epiphysis: This term specifies that the condition is not caused by a traumatic event, which is significant for diagnosis and treatment considerations.
3. Growth Plate Injury: While broader, this term encompasses conditions affecting the growth plate, including SUFE.
4. Hip Displacement: A general term that can refer to various conditions involving the displacement of the hip joint, including SUFE.
5. Femoral Head Slippage: This term describes the mechanical aspect of the condition, focusing on the slippage of the femoral head.

Clinical Context

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

In summary, the ICD-10 code M93.044 is associated with several alternative names and related terms that reflect the nature and specifics of the condition, which is essential for accurate diagnosis and treatment planning.

The diagnosis of Acute Slipped Upper Femoral Epiphysis (SUFE), Unstable (Nontraumatic), Bilateral Hips, represented by the ICD-10 code M93.044, involves a combination of clinical evaluation, imaging studies, and specific diagnostic criteria. Here’s a detailed overview of the criteria used for diagnosis:

Clinical Presentation

1. Symptoms: Patients typically 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 develop acutely or over a few weeks.

2. Age Group: SUFE commonly occurs in adolescents, particularly those aged between 10 and 16 years, during periods of rapid growth. The condition is more prevalent in males than females.

Physical Examination

1. Gait Assessment: Observation of the patient's gait can reveal limping or an antalgic gait due to pain.
2. Range of Motion: A physical examination will assess the range of motion in the hip joint, often revealing limitations in internal rotation and abduction.
3. Leg Position: The affected leg may be positioned in external rotation.

Imaging Studies

1. X-rays:
   - Initial Imaging: Anteroposterior (AP) and lateral X-rays of the hip are essential for diagnosis. These images will typically show:

   • Displacement of the femoral head relative to the femoral neck.
   • The degree of slippage can be assessed using the Southwick angle or the Klein line.
   • Bilateral Assessment: Since the diagnosis is for bilateral hips, X-rays should be evaluated for changes on both sides, even if symptoms are unilateral.

2. MRI or CT Scans: In some cases, advanced imaging may be utilized to assess the extent of the slippage and to evaluate for any associated complications, such as avascular necrosis.

Diagnostic Criteria

1. Unstable Classification: The unstable variant of SUFE is characterized by:
   - Significant displacement of the femoral head.
   - Increased risk of complications, including avascular necrosis and chondrolysis.
   - The instability is often indicated by the inability to maintain the femoral head in the acetabulum during physical examination or imaging.

2. Nontraumatic Nature: The diagnosis of nontraumatic SUFE indicates that the condition arose without a specific traumatic event, distinguishing it from traumatic slips that may occur due to injury.

Differential Diagnosis

It is crucial to differentiate SUFE from other conditions that may present similarly, such as:
- Perthes disease
- Osteomyelitis
- Fractures around the hip

Conclusion

The diagnosis of M93.044: Acute slipped upper femoral epiphysis, unstable (nontraumatic), bilateral hips is based on a combination of clinical symptoms, physical examination findings, and imaging studies. Early diagnosis and intervention are critical to prevent complications and ensure optimal outcomes for affected adolescents. If you suspect a case of SUFE, it is essential to refer the patient for appropriate imaging and orthopedic evaluation promptly.

Acute slipped upper femoral epiphysis (SUFE), particularly when classified under ICD-10 code M93.044, refers to a condition where the femoral head slips off the neck of the femur due to displacement of the growth plate. This condition is particularly concerning when it is unstable and affects both hips, as it can lead to significant complications if not treated promptly. Here’s a detailed overview of the standard treatment approaches for this condition.

Understanding Acute Slipped Upper Femoral Epiphysis

Definition and Symptoms

Acute SUFE typically occurs in adolescents during periods of rapid growth. Symptoms may include:
- Hip or groin pain
- Limited range of motion in the hip
- Limping or difficulty walking
- Pain that may refer to the knee

Diagnosis

Diagnosis is primarily made through clinical evaluation and imaging studies, such as X-rays, which reveal the displacement of the femoral head. MRI may be used in some cases to assess the extent of the slip and any associated complications.

Standard Treatment Approaches

1. Immediate Management

• Rest and Activity Modification: Patients are advised to limit weight-bearing activities to prevent further displacement of the femoral head. Crutches or a wheelchair may be recommended to assist mobility without putting weight on the affected hips.

2. Surgical Intervention

Surgical treatment is the cornerstone of managing unstable SUFE, especially in bilateral cases. The primary surgical options include:

• In Situ Fixation: This is the most common approach for acute, unstable SUFE. The procedure involves:

• Screw Fixation: A single cannulated screw is inserted into the femoral head to stabilize the epiphysis and prevent further slippage. This method is preferred due to its minimally invasive nature and effectiveness in maintaining the position of the femoral head.

• Open Reduction and Internal Fixation (ORIF): In cases where the slip is severe or there is significant displacement, an open surgical approach may be necessary to realign the femoral head before fixation.

3. Postoperative Care

• Rehabilitation: After surgery, a structured rehabilitation program is essential. This typically includes:
• Gradual weight-bearing as tolerated
• Physical therapy to restore range of motion and strength
• Monitoring for complications such as avascular necrosis or chondrolysis, which can occur post-surgery.

4. Long-term Follow-up

Regular follow-up appointments are crucial to monitor the healing process and ensure proper alignment of the femoral head. X-rays are typically performed at intervals to assess the stability of the fixation and the growth of the femur.

Conclusion

The management of acute slipped upper femoral epiphysis, particularly in unstable bilateral cases, requires prompt surgical intervention to prevent complications and ensure optimal outcomes. Early diagnosis and appropriate treatment are critical in preserving hip function and preventing long-term disability. Continuous monitoring and rehabilitation play vital roles in the recovery process, allowing patients to return to their normal activities safely. If you suspect SUFE, it is essential to consult with a healthcare professional for an accurate diagnosis and tailored treatment plan.