Lead Author(s): 

Scott B. Rosenfeld, MD
Brielle Payne Plost, MD

Supporting Author(s): 

Sylvia I. Watkins-Castillo, PhD

Deformity in children and adolescents is subdivided into five sections: upper extremity, lower extremity, hip and pelvis, spine, and other/unspecified.

Upper extremity deformity includes diagnoses such as polydactyly, syndactyly, and reduction deformities such as amyelia and longitudinal deficiencies of the upper extremity, and other congenital deformities such as synostosis, Madelung deformity, and Apert syndrome. A complete listing of deformity codes can be found in the ICD-9-CM Child and Adolescents Codes.

Lower extremity deformity includes diagnoses such as polydactyly, syndactyly, and reduction deformities such as amyelia and longitudinal deficiencies of the lower extremity, genu varum, genu valgum, and other congenital developmental deformities such as clubfoot and flatfoot.

Hip and pelvis deformity include diagnoses such as coxa valga, coxa vara, slipped capital femoral epiphysis, pelvic deformity, Legg Calves Perthes disease, and developmental dysplasia of the hip. Hip deformity is among the most common developmental deformities in childhood.  Developmental dysplasia of the hip is estimated to occur in between 1 in 100 to 1 in 1000 newborns.1

Spine deformity includes anomalies of the spinal cord such as syringomyelia and diastomatomyelia, as well as deformities of the vertebral column such as scoliosis, kyphosis, spondylolysis, spondylolisthesis, and congenital spinal anomalies.

Other and unspecified deformities include deformities of the chest wall such as pectus excavatum and pectus carinatum, as well as nonspecific deformity diagnoses.

Deformity of the spine represented the largest share of hospitalizations (40.7%) in 2013, followed by the lower extremity at 29% and upper extremity at 19.1%. (Reference Table 7C.3 PDF CSV

Healthcare Utilization

Musculoskeletal deformities were diagnosed in 1.7 million children and adolescent healthcare visits in 2013, of which 958,900 had a primary diagnosis of musculoskeletal deformity. Among the total with any diagnoses of deformity, 108,100 children and adolescents were hospital discharges, with 27,500 hospitalizations for a primary diagnosis of a musculoskeletal deformity. (Reference Table 7C.1.1 PDF CSV and Table 7C.1.2 PDF CSV)

Females had a slightly higher rate of overall deformity diagnoses with hospitalization, accounting for 52% of primary diagnosis. Neonates had a high rate of musculoskeletal deformity for any diagnosis with hospitalization (24.4%) but accounted for only 0.1% of primary hospitalizations of all musculoskeletal diagnoses. Primary diagnosis of musculoskeletal deformity with hospitalization was highest between the ages of 10 and 17 years.

Musculoskeletal deformity as a primary diagnosis accounted for 5.5% of hospitalizations for any musculoskeletal condition diagnosis, but only 0.4% of hospitalizations for any healthcare reason for children and adolescents age 20 years and under. (Reference Table 7C.3 PDF CSV)

Hospital Charges

Total charges averaged $70,700 for a mean 6.3-day stay when children and adolescents were hospitalized with a diagnosis of musculoskeletal deformity along with other medical conditions. With a primary diagnosis of deformity, the stay was shorter (4.1 days), but mean charges were much higher at $100,200, primarily due to the higher charges for children and adolescents age 10 years and older. Total hospital charges for all primary musculoskeletal deformity discharges in 2013 were $2.76 billion. (Reference Table 7C.3 PDF CSV)


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