ICD-10: M93.07

Acute on chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.07, is a condition that primarily affects adolescents and is 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

Definition and Mechanism

Acute on chronic slipped upper femoral epiphysis occurs when there is a sudden exacerbation of a previously stable or chronic condition. The femoral head slips posteriorly and inferiorly relative to the femoral neck, which can occur due to various factors, including hormonal changes, obesity, and mechanical stress on the hip joint[1].

Patient Demographics

• Age Group: Typically affects adolescents, particularly those aged 10 to 16 years.
• Gender: More common in males than females, with a ratio of approximately 2:1 to 3:1[1].
• Obesity: Higher prevalence in overweight or obese individuals, which may contribute to increased mechanical stress on the hip joint[1].

Signs and Symptoms

Common Symptoms

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

Physical Examination Findings

• Tenderness: Palpation of the hip joint may reveal tenderness over the greater trochanter and the anterior hip region.
• 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 in the unaffected hip[1].
• Muscle Spasms: There may be associated muscle spasms around the hip joint due to pain and instability.

Diagnostic Considerations

Imaging Studies

• X-rays: Anteroposterior and lateral views of the hip are essential for diagnosis. X-rays may show the degree of slippage and any associated changes in the femoral head and neck[1].
• MRI: In some cases, MRI may be utilized to assess the extent of the slippage and to evaluate for any associated bone marrow edema or other complications[1].

Conclusion

Acute on chronic slipped upper femoral epiphysis is a significant orthopedic condition that requires prompt recognition and management to prevent long-term complications such as avascular necrosis of the femoral head or osteoarthritis. Understanding the clinical presentation, signs, symptoms, and patient characteristics is crucial for healthcare providers to ensure timely diagnosis and appropriate treatment. If you suspect a case of SUFE, referral to an orthopedic specialist is recommended for further evaluation and management.

The ICD-10 code M93.07 refers to "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic)." This condition is a specific type of slipped capital femoral epiphysis (SCFE), which is a common hip disorder in adolescents. Below are alternative names and related terms associated with this condition:

Alternative Names

1. Acute on Chronic SCFE: This term emphasizes the acute exacerbation of a previously chronic condition.
2. Acute Slipped Capital Femoral Epiphysis: A more general term that may not specify the chronic aspect but refers to the acute presentation of the condition.
3. Chronic Slipped Capital Femoral Epiphysis with Acute Exacerbation: This phrase describes the condition's nature, highlighting both the chronic and acute components.

Related Terms

1. Slipped Capital Femoral Epiphysis (SCFE): The broader category under which M93.07 falls, referring to the displacement of the femoral head due to slippage at the growth plate.
2. Nontraumatic SCFE: Indicates that the condition is not caused by an acute injury, which is relevant for coding and diagnosis.
3. Hip Displacement: A general term that can encompass various conditions affecting the hip joint, including SCFE.
4. Femoral Head Displacement: This term specifically refers to the displacement of the femoral head, which is central to SCFE.

Clinical Context

Understanding these terms is crucial for healthcare professionals when diagnosing and coding for conditions related to hip disorders in pediatric patients. The distinction between acute and chronic presentations can significantly impact treatment decisions and management strategies.

In summary, M93.07 is associated with several alternative names and related terms that reflect its clinical significance and the nature of the condition. These terms are essential for accurate diagnosis, treatment planning, and medical coding.

The diagnosis of acute on chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.07, involves a combination of clinical evaluation, imaging studies, and specific criteria to differentiate it from other conditions. Here’s a detailed overview of the diagnostic criteria and considerations for this condition.

Clinical Presentation

1. Symptoms: Patients typically present with hip or groin pain, which may be acute or chronic in nature. The pain can be referred to the knee, and patients may exhibit a limp or reduced range of motion in the hip joint. Acute exacerbations of chronic symptoms are common, leading to the classification of the condition as "acute on chronic"[1].

2. Age Group: SUFE predominantly affects adolescents, particularly those aged between 10 and 16 years. The condition is more common in males and often occurs during periods of rapid growth[1].

Physical Examination

1. Range of Motion: A physical examination will often reveal limited internal rotation of the hip, which is a hallmark sign of SUFE. The affected leg may also appear shorter due to the displacement of the femoral head[1].

2. Limping: Patients may present with a characteristic limp, which can be indicative of pain or mechanical instability in the hip joint[1].

Imaging Studies

1. X-rays: The primary diagnostic tool is radiographic imaging. X-rays of the hip are essential to visualize the position of the femoral head relative to the femoral neck. In cases of acute on chronic SUFE, X-rays may show displacement of the femoral head, which can be classified as stable or unstable based on the degree of displacement and the presence of any associated symptoms[1][2].

2. MRI: In some cases, MRI may be utilized to assess the extent of the epiphyseal displacement and to evaluate for any associated bone marrow edema, which can indicate acute changes in a previously chronic condition[2].

Diagnostic Criteria

1. Acute on Chronic Diagnosis: The diagnosis of acute on chronic SUFE is made when there is evidence of a previously stable or chronic condition that has recently exacerbated. This may be indicated by a sudden increase in pain or a change in the clinical presentation, such as a new limp or increased difficulty in weight-bearing activities[1][2].

2. Stability Assessment: The stability of the slipped epiphysis is crucial for treatment planning. A stable slip typically allows for weight-bearing with crutches, while an unstable slip may require surgical intervention to prevent further displacement and complications[1].

Conclusion

Diagnosing acute on chronic slipped upper femoral epiphysis (ICD-10 code M93.07) involves a thorough clinical assessment, careful evaluation of symptoms, and appropriate imaging studies. The combination of these elements helps healthcare providers determine the best course of action for management and treatment, ensuring optimal outcomes for affected adolescents. If you have further questions or need additional information, feel free to ask!

Acute on chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.07, 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 appropriately. Here’s a detailed overview of the standard treatment approaches for this condition.

Understanding Slipped Upper Femoral Epiphysis

Definition and Causes

Slipped upper femoral epiphysis occurs when the femoral head slips off the neck of the femur at the growth plate, often due to mechanical stress or hormonal changes during periods of rapid growth. It can be classified as acute, chronic, or acute on chronic, depending on the duration and severity of symptoms. The acute on chronic variant indicates that the patient has a history of chronic slippage that has recently worsened[1].

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[1].

Standard Treatment Approaches

Initial Assessment

Before treatment, a thorough assessment is essential. This typically includes:
- Physical Examination: Evaluating the range of motion and pain levels.
- Imaging Studies: X-rays are crucial for diagnosing the degree of slippage and assessing the stability of the epiphysis. MRI may be used in some cases to evaluate the condition of the cartilage and surrounding tissues[1].

Non-Surgical Management

In cases where the slippage is stable and the patient is not experiencing severe symptoms, non-surgical management may be considered:
- Activity Modification: Reducing weight-bearing activities to alleviate stress on the hip joint.
- Pain Management: Use of analgesics or anti-inflammatory medications to manage pain and inflammation[1].

Surgical Intervention

Surgical treatment is often necessary, especially in cases of acute on chronic slippage or when the condition is unstable. The primary surgical options include:

1. In Situ Fixation: This is the most common procedure for stable slips. It involves the insertion of screws to stabilize the femoral head in its proper position. This method aims to prevent further slippage and allows for continued growth of the femur[1].

2. Osteotomy: In cases where there is significant deformity or instability, an osteotomy may be performed. This involves cutting and realigning the femur to improve the hip joint's mechanics and stability[1].

3. Open Reduction and Internal Fixation (ORIF): For unstable slips, especially in acute cases, ORIF may be necessary. This procedure involves realigning the femoral head and securing it with hardware to ensure proper healing and alignment[1].

Postoperative Care

Post-surgery, patients typically undergo:
- Rehabilitation: A structured physical therapy program to restore range of motion and strength.
- Follow-Up Imaging: Regular follow-up with X-rays to monitor healing and ensure that the epiphysis remains stable[1].

Conclusion

The management of acute on chronic slipped upper femoral epiphysis requires a careful balance between conservative and surgical approaches, tailored to the individual patient's needs and the severity of the condition. Early diagnosis and intervention are crucial to prevent complications such as avascular necrosis or osteoarthritis. Continuous monitoring and rehabilitation play vital roles in ensuring optimal recovery and function post-treatment. If you suspect this condition, consulting with an orthopedic specialist is essential for appropriate management.

Clinical Description of ICD-10 Code M93.07

ICD-10 Code M93.07 refers to "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic)." This condition is a specific type of slipped capital femoral epiphysis (SCFE), which is a disorder that typically occurs in adolescents during periods of rapid growth. Understanding this condition involves examining its clinical features, causes, diagnosis, and treatment options.

Definition and Pathophysiology

Slipped capital femoral epiphysis (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 disruption in the growth plate (physis). This slippage can be classified as either acute or chronic:

• Acute SCFE: This occurs suddenly, often following a minor injury or trauma, and is characterized by severe pain and limited mobility.
• Chronic SCFE: This develops gradually over time, with symptoms that may include hip or knee pain, limping, and decreased range of motion.

The term "acute on chronic" indicates that a patient with a pre-existing chronic condition has experienced an acute exacerbation, leading to increased symptoms and instability of the hip joint[1][4].

Clinical Features

Patients with acute on chronic SCFE may present with:

• Pain: Often localized to the hip, groin, or knee, which may worsen with activity.
• Limited Range of Motion: Particularly in internal rotation of the hip.
• Limping: A noticeable change in gait due to pain or mechanical instability.
• Deformity: In some cases, the affected leg may appear shorter or externally rotated.

Diagnosis

Diagnosis of M93.07 typically involves:

• Clinical Examination: Assessment of pain, range of motion, and gait abnormalities.
• Imaging Studies: X-rays are the primary diagnostic tool, revealing the degree of slippage and any associated changes in the femoral head and neck. MRI may be used in certain cases to assess the condition of the cartilage and surrounding structures[2][3].

Treatment Options

Management of acute on chronic SCFE focuses on stabilizing the femoral head and preventing further slippage. Treatment options may include:

• Surgical Intervention: The most common approach is surgical fixation using screws to stabilize the femoral head. This is crucial to prevent complications such as avascular necrosis (loss of blood supply to the femoral head) and further slippage.
• Non-Surgical Management: In some cases, particularly if surgery is not immediately feasible, conservative management may involve rest, activity modification, and pain management.

Prognosis

The prognosis for patients with acute on chronic SCFE largely depends on the timing of diagnosis and intervention. Early treatment can lead to favorable outcomes, while delays may result in complications such as chronic pain, joint dysfunction, or osteoarthritis later in life[5][6].

Conclusion

ICD-10 code M93.07 encapsulates a significant pediatric orthopedic condition that requires prompt recognition and management. Understanding the clinical presentation, diagnostic criteria, and treatment options is essential for healthcare providers to ensure optimal outcomes for affected individuals. Early intervention is key to preventing long-term complications associated with this condition.

For further information or specific case management strategies, consulting orthopedic specialists or pediatricians with expertise in hip disorders is recommended.