ICD-10: M93.063

Acute slipped upper femoral epiphysis (SUFE) is a condition characterized by the displacement of the femoral head due to slippage at the growth plate (physis) of the femur. This condition is particularly relevant in pediatric and adolescent populations, typically occurring during periods of rapid growth. The ICD-10 code M93.063 specifically refers to cases of acute slipped upper femoral epiphysis that are nontraumatic and have unspecified stability, affecting the unspecified hip.

Clinical Description

Definition

Acute slipped upper femoral epiphysis is defined as a displacement of the femoral head relative to the femoral neck, which occurs at the growth plate. This condition can lead to significant complications if not diagnosed and treated promptly. The term "acute" indicates that the condition has developed suddenly, often presenting with acute pain and limited mobility.

Etiology

The exact cause of acute slipped upper femoral epiphysis is not fully understood, but several factors may contribute, including:
- Hormonal Changes: Hormonal imbalances during puberty can affect bone growth and stability.
- Obesity: Increased body weight can place additional stress on the hip joint, potentially leading to slippage.
- Genetic Factors: A family history of SUFE may increase the risk of developing the condition.

Symptoms

Patients with acute slipped upper femoral epiphysis typically present with:
- Sudden onset of hip or groin pain, which may radiate to the knee.
- Limited range of motion in the hip joint, particularly internal rotation.
- Affected limb may appear externally rotated and may be held in a position of flexion.

Diagnosis

Diagnosis is primarily based on clinical evaluation and imaging studies. Key diagnostic steps include:
- Physical Examination: Assessment of hip range of motion and pain response.
- Imaging: X-rays are the standard imaging modality, revealing the degree of slippage and any associated changes in the femoral head.

Classification

The stability of the slip can be classified as:
- Stable: The patient can bear weight without significant pain.
- Unstable: The patient experiences severe pain and cannot bear weight.

The code M93.063 specifically refers to cases where the stability is unspecified, meaning that the clinical presentation does not clearly categorize the condition as stable or unstable.

Treatment

Management of acute slipped upper femoral epiphysis typically involves:
- Surgical Intervention: The most common treatment is surgical fixation of the femoral head to prevent further slippage and complications such as avascular necrosis.
- Non-Surgical Management: In some cases, particularly with stable slips, non-surgical management may be considered, including activity modification and close monitoring.

Prognosis

The prognosis for patients with acute slipped upper femoral epiphysis largely depends on the timing of diagnosis and treatment. Early intervention can lead to favorable outcomes, while delayed treatment may result in complications such as chronic pain, osteoarthritis, or avascular necrosis of the femoral head.

In summary, ICD-10 code M93.063 captures the clinical essence of acute slipped upper femoral epiphysis, emphasizing the need for prompt diagnosis and appropriate management to mitigate long-term complications associated with this condition.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.063, 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 slippage can be classified as stable or unstable, with the unspecified stability indicating that the degree of displacement is not clearly defined at the time of diagnosis. The condition is often nontraumatic, meaning it can occur without a specific injury or trauma, although some cases may be precipitated by minor trauma or stress.

Patient Demographics

• Age Group: Typically affects adolescents, particularly those between the ages of 10 and 16 years.
• Gender: More common in males than females, with a ratio of approximately 2:1.
• Obesity: Higher prevalence in overweight or obese adolescents, which may contribute to increased stress on the hip joint.

Signs and Symptoms

Common Symptoms

1. Hip Pain: Patients often present with hip pain that may be localized or referred to the knee. The pain can be acute and severe, or it may develop gradually.
2. Limited Range of Motion: There is often a noticeable reduction in the range of motion of the hip joint, particularly in internal rotation.
3. Limping: Affected individuals may exhibit a limp, which can be due to pain or mechanical instability in the hip.
4. Leg Positioning: The affected leg may appear externally rotated and may be held in a position of flexion and abduction.

Physical Examination Findings

• Tenderness: Palpation of the hip may reveal tenderness over the femoral head or groin area.
• Decreased Internal Rotation: A significant finding during the physical examination is the limitation of internal rotation of the hip, which is often more pronounced than limitations in other movements.
• Muscle Spasms: In some cases, muscle spasms around the hip may be observed.

Diagnostic Considerations

Imaging Studies

• X-rays: Standard imaging for diagnosis includes anteroposterior and lateral X-rays of the hip, which can reveal the characteristic slippage of the femoral head.
• MRI: In cases where X-rays are inconclusive, MRI may be utilized to assess the extent of slippage and to evaluate for associated complications such as avascular necrosis.

Conclusion

Acute slipped upper femoral epiphysis is a critical condition that requires prompt recognition and management to prevent long-term complications, including osteonecrosis and hip joint dysfunction. Awareness of the clinical presentation, including the characteristic signs and symptoms, is essential for healthcare providers, particularly in the pediatric and adolescent populations. Early diagnosis through appropriate imaging and clinical evaluation can lead to effective treatment strategies, which may include surgical intervention to stabilize the femoral head and prevent further slippage.

The ICD-10 code M93.063 refers to "Acute slipped upper femoral epiphysis, unspecified stability (nontraumatic), unspecified hip." This condition is a type of hip disorder that primarily affects adolescents, where the upper part of the femur (thigh bone) slips off the neck of the bone at the growth plate. Below are alternative names and related terms associated with this condition:

Alternative Names

1. Slipped Capital Femoral Epiphysis (SCFE): This is the most common alternative name for the condition, emphasizing the displacement of the femoral head.
2. Acute SCFE: This term specifies the acute nature of the condition, indicating a sudden onset.
3. Upper Femoral Epiphysis Displacement: A descriptive term that highlights the anatomical aspect of the condition.
4. Hip Slippage: A layman's term that may be used to describe the condition informally.

Related Terms

1. Nontraumatic Hip Disorder: This term indicates that the condition is not caused by an injury or trauma.
2. Growth Plate Injury: While SCFE is not always classified as a traditional injury, it involves the growth plate, which is crucial during development.
3. Hip Deformity: This term can be used to describe the resultant deformity from the slippage of the femoral head.
4. Pediatric Hip Disorder: Since SCFE primarily affects children and adolescents, this term is relevant in a broader context of hip disorders in younger populations.

Clinical Context

Understanding these alternative names and related terms is essential for healthcare professionals when diagnosing and discussing the condition. It aids in ensuring clear communication among medical teams and with patients regarding the nature of the disorder and its implications for treatment and management.

In summary, M93.063 is commonly referred to as SCFE, particularly in acute cases, and is associated with various terms that describe its clinical presentation and implications.

The diagnosis of ICD-10 code M93.063, which refers to "Acute slipped upper femoral epiphysis, unspecified stability (nontraumatic), unspecified hip," involves specific clinical criteria and considerations. Here’s a detailed overview of the diagnostic criteria and relevant information regarding this condition.

Understanding Slipped Upper Femoral Epiphysis (SUFE)

Definition

Slipped upper femoral epiphysis (SUFE) is a condition that typically occurs in adolescents, characterized by the displacement of the femoral head due to slippage at the growth plate (physis). This condition can be classified based on stability, which refers to whether the epiphysis is still in contact with the femoral neck (stable) or has completely slipped (unstable).

Acute Presentation

The acute form of SUFE is often associated with sudden onset symptoms, which may include:
- Hip or groin pain: This is often the primary complaint and can be referred to the knee.
- Limited range of motion: Patients may exhibit difficulty in internal rotation of the hip.
- Limping or altered gait: Due to pain and mechanical instability, patients may present with a limp.

Diagnostic Criteria

Clinical Evaluation

1. History Taking: A thorough medical history is essential, including any recent trauma, growth spurts, or symptoms of hip pain.
2. Physical Examination: The examination should focus on assessing hip range of motion, particularly internal rotation, and evaluating for tenderness in the hip region.

Imaging Studies

1. X-rays: The primary diagnostic tool for SUFE is plain radiography. X-rays of the hip should be obtained in both anteroposterior (AP) and lateral views to visualize the displacement of the femoral head.
   - Findings: Look for a characteristic "slip" of the femoral head relative to the femoral neck, which may appear as a posterior and inferior displacement.
2. MRI or CT Scans: In some cases, advanced imaging may be warranted to assess the extent of the slip or to evaluate for associated conditions.

Classification of Stability

• Unspecified Stability: The term "unspecified stability" in the ICD-10 code indicates that the clinician has not determined whether the slip is stable or unstable at the time of diagnosis. This may occur if the clinical presentation is acute and further evaluation is needed.

Differential Diagnosis

When diagnosing M93.063, it is crucial to differentiate SUFE from other conditions that may present similarly, such as:
- Transient synovitis: Often presents with hip pain and limping but typically has a more benign course.
- Perthes disease: Avascular necrosis of the femoral head, which usually occurs in younger children.
- Fractures: Particularly in the context of trauma, fractures around the hip should be ruled out.

Conclusion

The diagnosis of ICD-10 code M93.063 requires a combination of clinical assessment, imaging studies, and careful consideration of the patient's history and symptoms. The acute nature of the condition, along with the unspecified stability, necessitates prompt evaluation and management to prevent complications such as avascular necrosis or chronic hip pain. If you suspect SUFE, it is essential to refer the patient for orthopedic evaluation and management to ensure appropriate treatment and follow-up.

Acute slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.063, is a condition primarily affecting adolescents, where the femoral head slips off the neck of the femur at the growth plate. This condition 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 Causes

Acute slipped upper femoral epiphysis occurs when the growth plate (physis) weakens, allowing the femoral head to slip. This can happen due to various factors, including hormonal changes, obesity, and mechanical stress on the hip joint. The condition is often classified as either stable or unstable, with the unspecified stability indicating that the stability of the slip has not been determined at the time of diagnosis.

Symptoms

Common symptoms include:
- Hip or groin pain
- Limited range of motion in the hip
- Limping or altered gait
- Pain that may refer to the knee

Standard Treatment Approaches

1. Initial Assessment and Diagnosis

Before treatment, a thorough assessment is essential. This typically includes:
- Physical Examination: Assessing the range of motion and pain levels.
- Imaging Studies: X-rays are the primary diagnostic tool, but MRI may be used for further evaluation, especially in cases where the slip is not clearly visible on X-rays.

2. Non-Surgical Management

In cases where the slip is stable, non-surgical management may be considered, although this is less common for acute cases:
- Activity Modification: Limiting weight-bearing activities to reduce stress on the hip.
- Pain Management: Using analgesics or anti-inflammatory medications to manage pain.

3. Surgical Intervention

Surgical treatment is the standard approach for acute SUFE, especially when the slip is unstable or if there is significant displacement. The primary surgical options include:

a. In Situ Fixation

• Procedure: This involves the insertion of one or more screws through the femoral neck into the femoral head to stabilize the epiphysis.
• Indication: Typically used for stable slips where the blood supply to the femoral head is intact.

b. Open Reduction and Internal Fixation (ORIF)

• Procedure: If the slip is unstable or if there is significant displacement, an open reduction may be necessary to realign the femoral head before fixation.
• Indication: This is indicated for unstable slips or when there is a risk of avascular necrosis (loss of blood supply to the femoral head).

4. Postoperative Care

Post-surgery, the following care is crucial:
- Rehabilitation: Physical therapy to restore range of motion and strength.
- Follow-Up Imaging: Regular follow-up with X-rays to monitor the position of the femoral head and the healing process.
- Activity Restrictions: Gradual return to activities, with close monitoring for any signs of complications.

5. Long-Term Management

Patients may require long-term follow-up to monitor for potential complications, such as:
- Avascular necrosis
- Chondrolysis (joint cartilage breakdown)
- Early onset of osteoarthritis

Conclusion

Acute slipped upper femoral epiphysis is a serious condition that requires prompt diagnosis and treatment to prevent long-term complications. The standard treatment approach typically involves surgical intervention, particularly for unstable cases, followed by a structured rehabilitation program. Early recognition and appropriate management are key to ensuring optimal outcomes for affected adolescents. Regular follow-up is essential to monitor recovery and address any complications that may arise.