ICD-10: M93.061

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.061, is a condition primarily affecting adolescents, characterized by the displacement of the femoral head due to slippage of the growth plate (physis). 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

Definition and Mechanism

Acute slipped upper femoral epiphysis occurs when the femoral head slips off the neck of the femur at the growth plate. This condition is often classified as "acute" when the onset of symptoms is sudden, typically occurring over a few days. The "unspecified stability" indicates that the stability of the slip has not been determined, which can affect treatment decisions.

Patient Demographics

• Age Group: Most commonly affects adolescents aged 10 to 16 years, with a peak incidence around 12 years for girls and 14 years for boys[1].
• Gender: More prevalent in males than females, with a ratio of approximately 2:1[1].
• Obesity: Higher incidence in overweight or obese adolescents, likely due to increased mechanical stress on the hip joint[1].

Signs and Symptoms

Common Symptoms

1. Hip Pain: Patients typically present with pain in the hip or groin, which may be referred to the knee. The pain can be acute and severe, often worsening with activity[1].
2. Limited Range of Motion: There may be a noticeable reduction in the range of motion of the hip joint, particularly in internal rotation and abduction[1].
3. Limping: Affected individuals often exhibit a limp, which may be due to pain or mechanical instability in the hip joint[1].
4. Leg Positioning: The affected leg may appear externally rotated and shortened compared to the opposite leg[1].

Physical Examination Findings

• Tenderness: Palpation of the hip may reveal tenderness over the greater trochanter and the hip joint itself[1].
• Decreased Internal Rotation: During the physical examination, there is often a significant decrease in internal rotation of the hip joint, which is a key indicator of SUFE[1].
• Muscle Spasms: In some cases, muscle spasms around the hip may be observed, contributing to the limited mobility[1].

Diagnostic Imaging

• X-rays: Anteroposterior and lateral views of the hip are essential for diagnosis. X-rays will typically show the displacement of the femoral head relative to the femoral neck[1].
• MRI: In cases where the diagnosis is uncertain or to assess the stability of the slip, MRI may be utilized to provide detailed images of the hip joint and surrounding structures[1].

Conclusion

Acute slipped upper femoral epiphysis is a serious condition that requires prompt recognition and management to prevent complications such as avascular necrosis of the femoral head or chronic pain. Understanding the clinical presentation, including the characteristic signs and symptoms, as well as the typical patient demographics, is crucial for healthcare providers. Early diagnosis through appropriate imaging and timely intervention can significantly improve outcomes for affected adolescents. If you suspect a case of SUFE, it is essential to refer the patient for orthopedic evaluation and management.

The ICD-10 code M93.061 refers specifically to "Acute slipped upper femoral epiphysis, unspecified stability (nontraumatic), right hip." This condition is characterized by the displacement of the femoral head due to slippage at the growth plate, which can occur without a traumatic event. Below are alternative names and related terms associated with this condition:

Alternative Names

1. Acute Slipped Capital Femoral Epiphysis (SCFE): This is a more commonly used term that emphasizes the condition's acute nature and its relation to the capital femoral epiphysis.
2. Acute SCFE of the Right Hip: This term specifies the location and acute presentation of the condition.
3. Right Hip Slipped Upper Femoral Epiphysis: A straightforward description that indicates the affected area and the nature of the condition.

Related Terms

1. Slipped Femoral Epiphysis (SFE): A broader term that encompasses both acute and chronic forms of the condition, regardless of stability.
2. Nontraumatic Slipped Capital Femoral Epiphysis: This term highlights that the condition occurred without a traumatic event, distinguishing it from traumatic cases.
3. Hip Displacement: A general term that can refer to various conditions affecting the hip joint, including SCFE.
4. Growth Plate Injury: While not specific to SCFE, this term relates to injuries affecting the growth plate, which is where SCFE occurs.
5. Femoral Head Displacement: This term describes the result of the condition, where the femoral head is displaced from its normal position.

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 effective management of the patient's care.

In summary, M93.061 is associated with several alternative names and related terms that reflect its clinical presentation and implications. Recognizing these terms can enhance clarity in medical documentation and discussions.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.061, 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:
   - The clinician will gather a detailed medical history, focusing on symptoms such as hip or groin pain, limited range of motion, and any history of trauma, although SUFE is typically nontraumatic in nature.
   - The onset of symptoms is often gradual, and patients may report a limp or difficulty bearing weight on the affected leg.

2. Physical Examination:
   - A thorough physical examination is conducted to assess hip range of motion, leg positioning, and any signs of pain during movement.
   - The clinician may observe external rotation of the hip and a decreased internal rotation, which are indicative of SUFE.

Imaging Studies

1. X-rays:
   - Anteroposterior (AP) and lateral X-rays of the hip are essential for visualizing the displacement of the femoral head. The degree of slippage can be assessed through these images.
   - The Klein line, which is drawn along the superior border of the femoral neck, can help determine the degree of slippage by assessing where it intersects the femoral head.

2. MRI or CT Scans:
   - In some cases, MRI or CT scans may be utilized for a more detailed view, especially if the X-ray findings are inconclusive or if there is a need to evaluate the condition of the surrounding soft tissues.

Diagnostic Criteria

1. Classification of Stability:
   - The diagnosis of acute SUFE is categorized based on stability. In this case, "unspecified stability" indicates that the clinician has not determined whether the slip is stable (where the femoral head remains in contact with the acetabulum) or unstable (where it is not).
   - This classification is crucial for determining the appropriate management and treatment plan.

2. Exclusion of Other Conditions:
   - It is important to rule out other potential causes of hip pain and displacement, such as infections, tumors, or other orthopedic conditions.

3. Age Consideration:
   - SUFE typically occurs in adolescents, particularly those aged 10 to 16 years, and is more common in males. The age of the patient is a significant factor in the diagnosis.

Conclusion

The diagnosis of acute slipped upper femoral epiphysis (ICD-10 code M93.061) involves a comprehensive approach that includes patient history, physical examination, and imaging studies to confirm the presence of slippage at the femoral head. The classification of the condition's stability is also a critical component in guiding treatment decisions. Proper diagnosis is essential for effective management and to prevent complications such as avascular necrosis or further slippage.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.061, 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’s a detailed overview of 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 "acute" when the slippage occurs suddenly, typically presenting with hip pain, limited range of motion, and sometimes referred pain to the knee[1].

Symptoms

Patients may exhibit:
- Sudden hip pain
- Limping or difficulty walking
- Limited internal rotation of the hip
- Pain that may radiate to the knee[1].

Standard Treatment Approaches

Initial Assessment

Before treatment, a thorough clinical evaluation is essential, including:
- Physical Examination: Assessing range of motion and pain levels.
- Imaging Studies: X-rays are crucial for confirming the diagnosis and determining the degree of slippage[1].

Non-Surgical Management

In cases where the slip is minimal and the patient is stable, non-surgical management may be considered:
- Activity Modification: Limiting weight-bearing activities to reduce stress on the hip joint.
- Pain Management: Using analgesics or anti-inflammatory medications to alleviate pain[1].

Surgical Intervention

Surgical treatment is often necessary, especially in acute cases with significant slippage or instability. The primary surgical options include:

1. In Situ Fixation: This is the most common procedure, where screws are inserted to stabilize the femoral head in its proper position. This method is preferred for stable slips and aims to prevent further slippage and complications[1].

2. Osteotomy: In cases where there is significant deformity or instability, an osteotomy may be performed to realign the femur and improve joint mechanics. This is less common and typically reserved for more complex cases[1].

3. Follow-Up Care: Post-surgery, patients require regular follow-up to monitor healing and ensure proper alignment. Physical therapy may also be recommended to restore strength and mobility[1].

Complications and Considerations

Complications from untreated or improperly managed SUFE can include:
- Avascular necrosis of the femoral head
- Chondrolysis
- Early onset of osteoarthritis[1].

Conclusion

The management of acute slipped upper femoral epiphysis involves a combination of careful assessment, potential non-surgical approaches, and often surgical intervention to stabilize the hip joint. Early diagnosis and treatment are crucial to prevent long-term complications and ensure optimal outcomes for affected adolescents. Regular follow-up and rehabilitation are essential components of the recovery process to restore function and mobility.