ICD-10: M93.071

Acute on chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.071, 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 managed promptly. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this diagnosis.

Clinical Presentation

Definition and Background

Acute on chronic slipped upper femoral epiphysis refers to a situation where a previously stable (chronic) slippage of the femoral head becomes acute, often due to a sudden increase in stress or trauma. This condition is more common in adolescents, particularly during periods of rapid growth, and can occur in one or both hips, although the right hip is specified in this case.

Patient Characteristics

• Age Group: Typically affects children and adolescents aged 10 to 16 years, with a peak incidence around 12 years for girls and 14 years for boys[12].
• Gender: More prevalent in males, with a male-to-female ratio of approximately 2:1 to 3:1[12].
• Obesity: Higher incidence in overweight or obese individuals, which may contribute to the mechanical stress on the hip joint[12].
• Ethnicity: Some studies suggest variations in incidence among different ethnic groups, with higher rates observed in African American populations[12].

Signs and Symptoms

Common Symptoms

• Hip Pain: Patients often present with hip pain that may be localized to the groin, thigh, or knee. The pain can be acute or chronic, with acute exacerbations occurring in cases of acute on chronic slippage[12].
• 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[12].
• Limping: Affected individuals frequently exhibit a limp, which may be due to pain or mechanical instability in the hip joint[12].
• Referred Pain: Pain may be referred to the knee, which can sometimes lead to misdiagnosis as a knee issue rather than a hip problem[12].

Physical Examination Findings

• Decreased Internal Rotation: During physical examination, a significant decrease in internal rotation of the hip is often noted, which is a hallmark sign of SUFE[12].
• Leg Positioning: The affected leg may be held in an externally rotated position, and the patient may resist attempts to internally rotate the hip[12].
• Swelling and Tenderness: There may be tenderness over the hip joint, and in some cases, mild swelling can be observed[12].

Diagnosis and Imaging

Diagnosis is typically confirmed through imaging studies, including X-rays, which can reveal the degree of slippage and any associated changes in the femoral head. In cases of acute on chronic SUFE, X-rays may show a more pronounced displacement compared to previous studies if available[12].

Conclusion

Acute on chronic slipped upper femoral epiphysis is a significant orthopedic 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, signs, symptoms, and patient characteristics is crucial for healthcare providers to ensure timely diagnosis and appropriate treatment. If you suspect a case of SUFE, further evaluation through imaging and referral to an orthopedic specialist is recommended for optimal management.

ICD-10 code M93.071 refers to "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic), right hip." This condition is a specific type of hip disorder that primarily affects adolescents and is characterized by the displacement of the femoral head due to slippage at the growth plate.

Alternative Names

1. Slipped Capital Femoral Epiphysis (SCFE): This is the most common term used to describe the condition, encompassing both acute and chronic presentations.
2. Slipped Upper Femoral Epiphysis: A more descriptive term that highlights the location of the slippage.
3. Hip Slippage: A general term that may be used informally to describe the condition.
4. Femoral Head Displacement: This term refers to the displacement of the femoral head, which is a key feature of the condition.

Related Terms

1. Chronic Slipped Capital Femoral Epiphysis: Refers to cases where the slippage has been present for a longer duration, potentially leading to more severe complications.
2. Acute Slippage: This term is used when the condition presents suddenly, often with significant symptoms.
3. Nontraumatic Hip Disorder: A broader category that includes conditions like SCFE that are not caused by an acute injury.
4. Growth Plate Injury: Since SCFE involves the growth plate, this term is relevant in discussing the underlying pathology.
5. Hip Deformity: A general term that can encompass various conditions affecting the hip joint, including SCFE.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals when diagnosing and coding for this condition. Accurate coding ensures proper treatment and management, as well as appropriate billing and insurance claims processing. The distinction between acute and chronic presentations is particularly important, as it influences treatment decisions and potential outcomes.

In summary, M93.071 is associated with several alternative names and related terms that reflect its clinical significance and implications in pediatric orthopedics. Recognizing these terms can enhance communication among healthcare providers and improve patient care.

The diagnosis of ICD-10 code M93.071, which refers to "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic), right hip," involves specific clinical criteria and considerations. Here’s a detailed overview of the diagnostic criteria and relevant information regarding this condition.

Understanding Slipped Capital Femoral Epiphysis (SCFE)

Definition

Slipped Capital Femoral Epiphysis (SCFE) is a condition that 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. This condition is most common in adolescents and can be classified as either acute or chronic based on the duration and nature of the symptoms.

Acute on Chronic SCFE

• Acute on Chronic: This term indicates that a patient has a history of chronic SCFE, which has recently exacerbated, leading to acute symptoms. Chronic SCFE may present with intermittent pain and limited range of motion, while acute episodes can result in sudden, severe pain and functional impairment.

Diagnostic Criteria

Clinical Evaluation

1. History Taking:
   - A thorough medical history is essential, including any previous episodes of hip pain, mobility issues, or trauma.
   - The onset of symptoms should be documented, distinguishing between chronic symptoms and any acute exacerbation.

2. Physical Examination:
   - Assessment of hip range of motion, particularly internal rotation, which is often limited in SCFE.
   - Evaluation for signs of pain during movement, particularly when the hip is flexed and internally rotated.

Imaging Studies

1. X-rays:
   - Anteroposterior (AP) and lateral views of the hip are crucial for visualizing the displacement of the femoral head.
   - The degree of slippage can be assessed using the Southwick angle or the slip angle.

2. MRI or CT Scans (if necessary):
   - These imaging modalities may be used to evaluate the extent of the slippage and to assess for any associated complications, such as avascular necrosis.

Classification of Stability

• Unspecified Stability: In cases where the stability of the slip is not clearly defined, it may be categorized as unspecified. Stability refers to whether the femoral head is still partially or fully attached to the growth plate.

Conclusion

The diagnosis of ICD-10 code M93.071 requires a combination of clinical history, physical examination, and imaging studies to confirm the presence of acute on chronic SCFE in the right hip. Proper classification of the condition is essential for determining the appropriate management and treatment options. If you have further questions or need additional information on treatment protocols or management strategies, feel free to ask!

Acute on chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.071, is a condition that primarily affects adolescents and involves the displacement of the femoral head due to slippage at the growth plate. This condition can lead to significant complications if not managed appropriately. Here’s a detailed overview of standard treatment approaches for this condition.

Understanding Acute on Chronic Slipped Upper Femoral Epiphysis

Definition and Causes

SUFE occurs when the femoral head slips off the neck of the femur at the growth plate, which can be exacerbated by chronic conditions. The "acute on chronic" designation indicates that the patient has a history of chronic slippage that has recently worsened, leading to acute symptoms. Factors contributing to this condition include hormonal changes, obesity, and mechanical stress on the hip joint[1].

Symptoms

Patients typically present with hip pain, limited range of motion, and sometimes referred pain to the knee. The acute phase may involve sudden worsening of symptoms, which can complicate the clinical picture[1].

Standard Treatment Approaches

1. Initial Assessment and Diagnosis

Before treatment, a thorough assessment is essential. This includes:
- Clinical 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 for further evaluation if necessary[1].

2. Non-Surgical Management

In cases where the condition is stable and the patient is not experiencing severe symptoms, conservative management may be appropriate:
- Activity Modification: Limiting weight-bearing activities to reduce stress on the hip joint.
- Pain Management: Nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and inflammation[1].

3. Surgical Intervention

Surgery is often indicated, especially in cases of acute on chronic SUFE due to the risk of avascular necrosis and further slippage. Surgical options include:
- In Situ Fixation: This is the most common procedure, where screws are placed to stabilize the femoral head in its proper position. This approach is typically performed arthroscopically or through an open surgical technique[1].
- Osteotomy: In some cases, a femoral osteotomy may be performed to correct the alignment of the femur and relieve pressure on the growth plate, particularly if there is significant deformity or instability[1].

4. Postoperative Care

Post-surgery, patients require careful monitoring and rehabilitation:
- Physical Therapy: A structured rehabilitation program is essential to restore range of motion and strength. This typically begins with gentle exercises and progresses as tolerated[1].
- Follow-Up Imaging: Regular follow-up with X-rays is necessary to monitor the position of the femoral head and ensure proper healing[1].

5. Long-Term Management

Patients with SUFE may be at risk for long-term complications, including osteoarthritis and hip dysfunction. Ongoing assessment and management of hip function are crucial as the patient matures[1].

Conclusion

The management of acute on chronic slipped upper femoral epiphysis involves a combination of careful assessment, potential surgical intervention, and comprehensive postoperative care. Early diagnosis and appropriate treatment are vital to prevent complications and ensure optimal outcomes for affected adolescents. Regular follow-up and rehabilitation play critical roles in the long-term success of treatment strategies for this condition.

Clinical Description of ICD-10 Code M93.071

ICD-10 Code M93.071 refers to a specific condition known as "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic), right hip." This diagnosis falls under the broader category of osteochondropathies, which are disorders affecting the growth and development of bone and cartilage.

Definition and Pathophysiology

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 slippage can be classified as either acute or chronic:

• Acute Slippage: This occurs suddenly, often presenting with severe pain and limited mobility.
• Chronic Slippage: This develops gradually, with symptoms that may include hip or knee pain, limping, and decreased range of motion.

In the case of M93.071, the term "acute on chronic" indicates that a patient with a pre-existing chronic condition has experienced an acute exacerbation, leading to a sudden worsening of symptoms. The unspecified stability suggests that the degree of stability of the epiphysis at the time of diagnosis is not clearly defined, which can complicate treatment decisions.

Clinical Presentation

Patients with acute on chronic slipped upper femoral epiphysis may present with:

• Pain: Often localized to the hip or groin, which may radiate to the knee.
• Limited Range of Motion: Particularly in internal rotation and abduction of the hip.
• Limping: Due to pain and mechanical instability.
• Deformity: In some cases, the affected leg may appear shorter or externally rotated.

Diagnosis

Diagnosis typically involves a combination of clinical evaluation and imaging studies:

• Physical Examination: Assessment of hip range of motion, gait analysis, and palpation for tenderness.
• Imaging: X-rays are the primary diagnostic tool, revealing the degree of slippage and any associated changes in the femoral head.

Treatment Options

Management of acute on chronic slipped upper femoral epiphysis may include:

• Non-Surgical: In cases where the condition is stable, treatment may involve rest, activity modification, and pain management.
• Surgical Intervention: For unstable cases or significant slippage, surgical options such as in situ fixation (using screws to stabilize the femoral head) may be necessary to prevent further slippage and complications like avascular necrosis.

Conclusion

ICD-10 code M93.071 captures a complex clinical scenario involving acute exacerbation of a chronic condition affecting the hip joint. Understanding the nuances of this diagnosis is crucial for appropriate management and treatment planning. Early recognition and intervention can significantly improve outcomes for affected adolescents, preventing long-term complications associated with slipped upper femoral epiphysis.