ICD-10: M93.074

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 (physis). This condition is particularly relevant in pediatric and adolescent populations, and it can present with a variety of clinical features. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with ICD-10 code M93.074, which refers to acute on chronic slipped upper femoral epiphysis, unspecified stability, affecting both hips.

Clinical Presentation

Definition and Background

Acute on chronic slipped upper femoral epiphysis occurs when there is a sudden worsening of a previously stable condition. The epiphysis, which is the rounded end of the femur, slips due to mechanical stress or hormonal changes, leading to pain and functional impairment. This condition is often bilateral, meaning it can affect both hips simultaneously, although it may not always be diagnosed at the same time.

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.
• Obesity: Higher prevalence in overweight or obese children, which may contribute to the mechanical stress on the hip joint.

Signs and Symptoms

Common Symptoms

1. Hip Pain: Patients often report pain in the hip or groin area, which may be acute or chronic in nature. The pain can be exacerbated by activity and may be referred to the knee.
2. Limited Range of Motion: There may be a noticeable decrease in the range of motion of the hip joint, particularly in internal rotation.
3. Limping: Affected individuals may present with a limp, which can be due to pain or mechanical instability.
4. Leg Positioning: The affected leg may appear externally rotated and shortened compared to the unaffected leg.

Physical Examination Findings

• Tenderness: Palpation of the hip joint may reveal tenderness over the greater trochanter and the hip joint itself.
• Decreased Internal Rotation: A significant limitation in internal rotation of the hip is often observed during physical examination.
• Muscle Spasms: There may be associated muscle spasms around the hip joint due to pain and instability.

Diagnostic Considerations

Imaging Studies

• X-rays: Standard imaging is crucial for diagnosis. X-rays may show the degree of slippage and any changes in the femoral head.
• 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.

Differential Diagnosis

• Transient Synovitis: This condition can present similarly but typically has a more acute onset and is often self-limiting.
• Osteomyelitis: Infection of the bone can mimic the symptoms of SUFE but usually presents with systemic signs of infection.
• Fractures: Stress fractures or other traumatic injuries should be ruled out, especially in active adolescents.

Conclusion

Acute on chronic slipped upper femoral epiphysis is a significant condition that requires prompt recognition and management to prevent complications such as avascular necrosis or further slippage. The clinical presentation typically includes hip pain, limited range of motion, and a characteristic limp, particularly in adolescents who may be overweight. Early diagnosis through clinical evaluation and imaging is essential for effective treatment and to minimize long-term consequences. If you suspect this condition in a patient, referral to an orthopedic specialist is recommended for further evaluation and management.

ICD-10 code M93.074 refers to "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic), bilateral hips." This condition is a specific type of hip disorder that affects the growth plate of the femur, leading to slippage of the femoral head. Below are alternative names and related terms associated with this diagnosis.

Alternative Names

1. Slipped Capital Femoral Epiphysis (SCFE): This is the most common term used to describe the condition, particularly in pediatric populations.
2. Slipped Upper Femoral Epiphysis: A more descriptive term that emphasizes the location of the slippage.
3. Acute Slipped Capital Femoral Epiphysis: This term highlights the acute nature of the condition, which can occur on a background of chronic slippage.
4. Bilateral SCFE: Indicates that the condition affects both hips.

Related Terms

1. Epiphyseal Displacement: A general term that refers to the displacement of the epiphysis, which is relevant in the context of SCFE.
2. Hip Dysplasia: While not the same condition, hip dysplasia can be related in terms of hip joint abnormalities.
3. Nontraumatic Hip Disorder: This term encompasses various hip conditions that are not caused by trauma, including SCFE.
4. Growth Plate Injury: Refers to injuries affecting the growth plate, which is relevant in understanding the underlying pathology of SCFE.
5. Chronic Slipped Capital Femoral Epiphysis: This term may be used to describe cases where the condition has been present for an extended period before an acute episode occurs.

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 SCFE.

In summary, M93.074 is associated with several alternative names and related terms that reflect its clinical significance and implications in pediatric orthopedics.

The ICD-10 code M93.074 refers to "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic), bilateral hips." This condition is a specific type of slipped capital femoral epiphysis (SCFE), which is characterized by the displacement of the femoral head due to slippage at the growth plate. Understanding the diagnostic criteria for this condition is crucial for accurate coding and treatment.

Diagnostic Criteria for M93.074

1. Clinical Presentation

• Symptoms: Patients typically present with hip or knee pain, which may be acute or chronic. The pain can be exacerbated by activity and may be accompanied by a limp.
• Age Group: SCFE commonly occurs in adolescents, particularly during periods of rapid growth, typically between ages 10 and 16.

2. Physical Examination

• Range of Motion: Limited internal rotation of the hip is often noted during physical examination. The affected leg may also appear shorter or externally rotated.
• Limp: A noticeable limp may be present, which can help differentiate SCFE from other hip conditions.

3. Imaging Studies

• X-rays: The primary diagnostic tool is radiographic imaging. X-rays of the hip are essential to visualize the displacement of the femoral head. In cases of acute on chronic SCFE, there may be evidence of both acute slippage and chronic changes, such as deformity of the femoral head.
• MRI or CT Scans: In some cases, advanced imaging may be utilized to assess the extent of slippage and to evaluate the stability of the epiphysis.

4. Classification of Stability

• Unspecified Stability: The term "unspecified stability" indicates that the stability of the slipped epiphysis has not been clearly defined. Stability is typically classified as stable (where the patient can bear weight) or unstable (where weight-bearing causes significant pain and risk of further slippage). In this case, the diagnosis does not specify which category the condition falls into.

5. Exclusion of Traumatic Causes

• Nontraumatic Nature: The diagnosis specifies that the condition is nontraumatic, meaning it is not the result of an acute injury. This is important for differentiating SCFE from other hip conditions that may arise from trauma.

Conclusion

The diagnosis of M93.074 involves a combination of clinical evaluation, imaging studies, and an understanding of the patient's history and symptoms. Accurate diagnosis is essential for appropriate management, which may include surgical intervention to stabilize the femoral head and prevent further complications. If you have further questions or need additional information on treatment options, feel free to ask!

Acute on chronic slipped upper femoral epiphysis (SUFE), particularly when classified under ICD-10 code M93.074, refers to a condition where the femoral head slips off the neck of the femur due to a combination of chronic and acute factors. This condition is particularly concerning in pediatric populations and can lead to significant complications if not managed appropriately. Below, we explore standard treatment approaches for this condition.

Understanding Slipped Upper Femoral Epiphysis

Definition and Causes

Slipped upper femoral epiphysis occurs when the growth plate (physis) of the femur becomes unstable, leading to slippage. This can be acute, chronic, or a combination of both. The acute on chronic variant indicates that there has been a pre-existing condition that has suddenly worsened. Factors contributing to this condition may include hormonal changes, obesity, and mechanical stress on the hip joint.

Symptoms

Patients typically present with hip pain, limited range of motion, and sometimes a limp. In cases of acute on chronic SUFE, symptoms may escalate rapidly, necessitating prompt medical attention.

Standard Treatment Approaches

1. Initial Assessment and Diagnosis

• Clinical Evaluation: A thorough history and physical examination are essential. The clinician will assess the range of motion, pain levels, and any signs of instability.
• Imaging Studies: X-rays are the primary diagnostic tool, often supplemented by MRI or CT scans to evaluate the extent of slippage and any associated complications.

2. Non-Surgical Management

In cases where the slip is minimal and the patient is stable, conservative management may be considered:
- Activity Modification: Patients are advised to limit weight-bearing activities to prevent further slippage.
- Pain Management: Analgesics and anti-inflammatory medications can help manage pain and inflammation.
- Physical Therapy: Gentle range-of-motion exercises may be introduced to maintain joint function without exacerbating the condition.

3. Surgical Intervention

Surgery is often indicated, 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.
- Open Reduction and Internal Fixation (ORIF): In cases where the slip is unstable or there is significant displacement, an open surgical approach may be necessary to realign the femoral head and secure it with hardware.
- Salter Osteotomy: In some cases, particularly with severe deformity or instability, a pelvic osteotomy may be performed to improve hip joint stability and alignment.

4. Postoperative Care

• Rehabilitation: Post-surgery, a structured rehabilitation program is crucial. This may include physical therapy to restore strength and mobility.
• Follow-Up Imaging: Regular follow-up with imaging studies is necessary to monitor the healing process and ensure that the femoral head remains stable.

5. Long-Term Management

Patients with a history of SUFE may require ongoing monitoring for potential complications, including osteoarthritis or further slippage. Education on maintaining a healthy weight and avoiding activities that place excessive stress on the hips is also important.

Conclusion

The management of acute on chronic slipped upper femoral epiphysis, particularly in bilateral cases, requires a comprehensive approach that includes accurate diagnosis, appropriate surgical intervention when necessary, and diligent postoperative care. Early recognition and treatment are key to preventing long-term complications and ensuring optimal outcomes for affected individuals. Regular follow-ups and lifestyle modifications play a crucial role in the long-term management of this condition.

Clinical Description of ICD-10 Code M93.074

ICD-10 Code M93.074 refers to a specific condition known as "Acute on chronic slipped upper femoral epiphysis, unspecified stability (nontraumatic), bilateral hips." 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 condition can be classified as either acute or chronic, depending on the duration and nature of the symptoms.

• Acute on Chronic: This term indicates that the patient has a history of chronic slippage, which has now exacerbated into an acute episode. The chronic phase may involve gradual displacement, while the acute phase is marked by sudden worsening of symptoms, such as pain and limited mobility.
• Unspecified Stability: This designation means that the stability of the slipped epiphysis has not been clearly defined. Stability refers to whether the femoral head remains in place (stable) or has moved significantly (unstable).

Clinical Presentation

Patients with M93.074 may present with the following symptoms:

• Hip Pain: Often localized to the groin or thigh, which may worsen with activity.
• Limited Range of Motion: Particularly in internal rotation and abduction of the hip.
• Limping: Patients may exhibit a limp due to pain or mechanical instability.
• Referred Pain: Pain may also be felt in the knee, which can sometimes lead to misdiagnosis.

Diagnosis

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

• Physical Examination: Assessment of hip range of motion, gait analysis, and evaluation of pain response.
• Imaging: X-rays are the primary diagnostic tool, revealing the degree of slippage and any associated changes in the femoral head. MRI may be used for further evaluation, especially in cases where the X-ray findings are inconclusive.

Treatment Options

Management of acute on chronic slipped upper femoral epiphysis generally involves:

• Surgical Intervention: The primary treatment is often surgical fixation of the femoral head to prevent further slippage and complications. This may involve the use of screws or pins.
• Non-Surgical Management: In some cases, particularly if the condition is stable, conservative management with activity modification and physical therapy may be considered.

Prognosis

The prognosis for patients with M93.074 can vary based on the severity of the slippage, the timing of intervention, and the presence of any complications. Early diagnosis and treatment are crucial for optimal outcomes, as untreated cases can lead to complications such as avascular necrosis of the femoral head or early osteoarthritis.

Conclusion

ICD-10 code M93.074 encapsulates a significant clinical condition that requires careful assessment and management. Understanding the nuances of acute on chronic slipped upper femoral epiphysis, including its symptoms, diagnostic criteria, and treatment options, is essential for healthcare providers to ensure effective patient care and improve outcomes. Early intervention is key to preventing long-term complications associated with this condition.