ICD-10: M93.073

ICD-10 code M93.073 refers to "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic), unspecified hip." This diagnosis is part of the broader category of conditions affecting the hip joint, particularly in relation to the growth plate of the femur.

Clinical Description

Definition

Slipped upper femoral epiphysis (SUFE) 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 at the growth plate. This condition can be classified as either acute or chronic, depending on the duration and nature of the symptoms. 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.

Causes

The exact cause of slipped capital femoral epiphysis is not fully understood, but it is often associated with:
- Hormonal changes during adolescence
- Obesity, which can increase stress on the hip joint
- Genetic predisposition
- Endocrine disorders

Symptoms

Patients with acute on chronic slipped upper femoral epiphysis may present with:
- Hip pain, which may be referred to the knee
- Limited range of motion in the hip
- Limping or altered gait
- Symptoms that may have been present for a longer duration (chronic) but have recently worsened (acute)

Diagnosis

Diagnosis typically involves:
- Clinical examination to assess pain and mobility
- Imaging studies, such as X-rays, to visualize the position of the femoral head and neck
- MRI may be used in some cases to assess the extent of the slip and any associated changes in the bone structure.

Treatment

Management of acute on chronic slipped upper femoral epiphysis may include:
- Surgical intervention to stabilize the femoral head, often through pinning or other fixation methods
- Non-surgical management may be considered in less severe cases, focusing on pain relief and physical therapy.

Unspecified Stability

The term "unspecified stability" indicates that the stability of the epiphysis has not been clearly defined in the diagnosis. This can complicate treatment decisions, as the stability of the slip can influence the urgency and type of intervention required.

Conclusion

ICD-10 code M93.073 captures a specific and complex condition that requires careful clinical evaluation and management. Understanding the nuances of acute on chronic slipped upper femoral epiphysis is crucial for healthcare providers to ensure appropriate treatment and to mitigate potential complications associated with this condition. Early diagnosis and intervention are key to improving outcomes for affected patients.

Acute on chronic slipped upper femoral epiphysis (SUFE) is a condition characterized by the displacement of the femoral head due to slippage at the growth plate, which can occur acutely on a background of chronic slippage. This condition is particularly relevant in pediatric populations and can lead to significant complications if not diagnosed and managed appropriately. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with ICD-10 code M93.073.

Clinical Presentation

Definition and Background

Acute on chronic slipped upper femoral epiphysis refers to a situation where a patient with a history of chronic SUFE experiences an acute exacerbation of symptoms. This condition typically affects adolescents, particularly those who are overweight or have hormonal imbalances, and is more common in males than females[1][2].

Patient Characteristics

• Age: Most commonly seen in adolescents aged 10 to 16 years.
• Gender: Higher prevalence in males, with a male-to-female ratio of approximately 2:1 to 3:1[3].
• Obesity: Increased body mass index (BMI) is a significant risk factor, as excess weight can place additional stress on the hip joint[4].
• Hormonal Factors: Conditions such as hypothyroidism or other endocrine disorders may predispose individuals to this condition[5].

Signs and Symptoms

Common Symptoms

• Hip Pain: Patients often present with hip pain that may be localized or referred to the knee. The pain can be acute or chronic, depending on the nature of the slippage[6].
• Limited Range of Motion: There may be a noticeable decrease in the range of motion of the hip joint, particularly in internal rotation and abduction[7].
• Limping: Affected individuals may exhibit a limp, which can be due to pain or mechanical instability in the hip joint[8].
• Leg Positioning: The affected leg may appear externally rotated and may be held in a position of flexion[9].

Physical Examination Findings

• Tenderness: Palpation of the hip may reveal tenderness over the greater trochanter and the hip joint itself[10].
• Decreased Mobility: The clinician may observe a significant reduction in the ability to move the hip joint, particularly in internal rotation[11].
• Muscle Atrophy: In chronic cases, there may be signs of muscle atrophy around the hip and thigh due to disuse[12].

Diagnosis and Imaging

Diagnosis is typically confirmed through imaging studies, including:
- X-rays: Anteroposterior and lateral views of the hip can reveal the degree of slippage and any associated changes in the femoral head[13].
- MRI: In some cases, MRI may be utilized to assess the extent of the slippage and to evaluate for any associated complications, such as avascular necrosis[14].

Conclusion

Acute on chronic slipped upper femoral epiphysis is a significant condition that requires prompt recognition and management to prevent long-term complications, including osteoarthritis and avascular necrosis. Understanding the clinical presentation, signs, symptoms, and patient characteristics is crucial for healthcare providers to ensure timely intervention. If you suspect a case of SUFE, it is essential to refer the patient for appropriate imaging and orthopedic evaluation to determine the best course of action.

ICD-10 code M93.073 refers to "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic), unspecified hip." This condition is a specific type of hip disorder that involves the displacement of the femoral head due to slippage at the growth plate, which can occur acutely on a background of chronic slippage.

Alternative Names

1. Slipped Capital Femoral Epiphysis (SCFE): This is the most common term used to describe the condition, emphasizing the slippage of the femoral head at the growth plate.
2. Slipped Upper Femoral Epiphysis: A more descriptive term that highlights the location of the slippage.
3. Acute Slipped Femoral Epiphysis: This term may be used when the condition presents acutely, indicating a sudden change in the stability of the hip.
4. Chronic Slipped Femoral Epiphysis: This term refers to cases where the slippage has been ongoing before an acute episode occurs.

Related Terms

1. Hip Displacement: A broader term that can encompass various types of hip joint dislocations, including SCFE.
2. Femoral Head Displacement: This term specifically refers to the displacement of the femoral head, which is central to the condition.
3. Growth Plate Injury: Since SCFE involves the growth plate, this term can be relevant in discussing the underlying mechanisms.
4. Nontraumatic Hip Disorder: This term indicates that the condition is not caused by an acute injury, which is a key aspect of M93.073.
5. Epiphyseal Slippage: A technical term that describes the movement of the epiphysis relative to the femoral neck.

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 management and treatment of patients with this hip disorder.

In summary, M93.073 is associated with several alternative names and related terms that reflect its clinical presentation and underlying pathology. Familiarity with these terms can enhance clarity in medical documentation and discussions.

The diagnosis of ICD-10 code M93.073, which refers to "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic), unspecified hip," involves several clinical criteria and considerations. This condition is characterized by a displacement of the femoral head due to slippage at the growth plate, which can occur acutely on a background of chronic slippage. Here’s a detailed overview of the diagnostic criteria and relevant considerations:

Clinical Presentation

1. Symptoms: Patients typically present with hip pain, which may be acute or chronic. The pain can be localized to the hip or referred to the knee, and it may be accompanied by a limp or decreased range of motion in the affected hip.

2. Age Group: Slipped capital femoral epiphysis (SCFE) commonly occurs in adolescents, particularly during periods of rapid growth. The age range is usually between 10 to 16 years, with a higher prevalence in males.

3. History: A thorough medical history is essential, including any previous episodes of hip pain or instability, as well as any history of trauma, although the condition is classified as nontraumatic in this case.

Physical Examination

1. Range of Motion: A physical examination will often reveal limited internal rotation of the hip, which is a hallmark sign of SCFE. The hip may also be held in a position of external rotation.

2. Limp: The patient may exhibit a limp, which can be indicative of pain or mechanical instability in the hip joint.

Imaging Studies

1. X-rays: The primary diagnostic tool for SCFE is radiographic imaging. X-rays of the hip are crucial for visualizing the displacement of the femoral head. In cases of acute on chronic SCFE, X-rays may show varying degrees of slippage, which can be classified as mild, moderate, or severe.

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

Diagnostic Criteria

1. Classification of Stability: The stability of the slip is an important factor in diagnosis. In this case, the term "unspecified stability" indicates that the clinician has not determined whether the slip is stable (no significant displacement) or unstable (significant displacement with risk of further complications).

2. Nontraumatic Nature: The diagnosis specifies that the condition is nontraumatic, meaning that it has developed without a specific traumatic event leading to the slippage.

3. Unspecified Hip: The designation of "unspecified hip" indicates that the diagnosis does not specify which hip is affected, which may be relevant in cases where bilateral involvement is possible.

Conclusion

The diagnosis of ICD-10 code M93.073 requires a comprehensive approach that includes clinical evaluation, imaging studies, and consideration of the patient's history. The combination of acute symptoms on a background of chronic slippage, along with the physical examination findings and radiographic evidence, forms the basis for this diagnosis. Proper identification and management are crucial to prevent complications such as avascular necrosis or further displacement of the femoral head.

Acute on chronic slipped upper femoral epiphysis (SUFE), classified under ICD-10 code M93.073, 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 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, typically due to mechanical stress and hormonal changes during periods of rapid growth. The "acute on chronic" designation indicates that the patient has a history of chronic slippage that has recently worsened, leading to acute symptoms such as pain and limited mobility[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[2].

Standard Treatment Approaches

1. Initial Assessment and Diagnosis

Before treatment, a thorough assessment is essential. This typically includes:
- Physical Examination: Evaluating hip range of motion and assessing for pain.
- Imaging Studies: X-rays are the primary diagnostic tool, often supplemented by MRI if further detail is needed to assess the extent of slippage and any associated complications[3].

2. Non-Surgical Management

In cases where the condition 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 nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation[4].
- Physical Therapy: Gentle exercises may be recommended to maintain hip mobility without exacerbating the condition.

3. Surgical Intervention

Surgical treatment is often necessary, especially in cases of acute on chronic SUFE, to prevent further slippage and complications such as avascular necrosis. Common surgical approaches include:
- In Situ Fixation: This is the most common procedure, where screws are placed to stabilize the femoral head in its proper position. This method is preferred for stable slips and can be performed arthroscopically or through an open approach[5].
- Osteotomy: In cases of severe deformity or instability, an osteotomy may be performed to realign the femur and improve joint mechanics[6].

4. Postoperative Care

Post-surgery, patients typically undergo:
- Rehabilitation: A structured physical therapy program to restore strength and range of motion.
- Follow-Up Imaging: Regular follow-up with X-rays to monitor the position of the femoral head and the healing process[7].

5. Long-Term Management

Long-term follow-up is crucial to monitor for potential complications, including:
- Avascular Necrosis: A serious condition where the blood supply to the femoral head is compromised, leading to bone death.
- Early Osteoarthritis: Patients may be at increased risk for developing arthritis in the hip joint later in life due to the altered mechanics from the slippage[8].

Conclusion

The management of acute on chronic slipped upper femoral epiphysis requires a comprehensive approach that includes accurate diagnosis, appropriate surgical intervention when necessary, and diligent postoperative care. Early recognition and treatment are vital to prevent complications and ensure optimal outcomes for affected adolescents. Regular follow-up is essential to monitor recovery and address any long-term issues that may arise. If you suspect this condition, consulting with an orthopedic specialist is crucial for tailored management.