Epiphysiolysis capitis femoris (ECF)

Synonyms

Juvenile epiphyseal detachment, adolescent epiphysiolysis, epiphyseal detachment, epiphysesolysis, epiphysesolysis

definition

Epiphyseolysis capitis femoris is understood to be the detachment and sliding or tilting of the head of the femoral neck in the growth plate from the femoral neck. This clinical picture occurs during the puberty and is rarely acute, but rather over weeks and months.

Age

This disease is a separate clinical picture of the adolescent age. It usually occurs between the ages of 9 and the end of growth.

Gender distribution

Boys tend to develop epiphysiolysis more often. The ratio between male and female is 3: 1. In about 50% of all cases, the disease occurs on both sides.

frequency

The probability of the occurrence of this disease is around 1: 10,000, whereby - as already mentioned, male adolescents are more frequently affected.

to form

1. imminens (= threatening)
   This is an incipient epiphyseal detachment, which can only be recognized by X-ray diagnosis as a loosened epiphyseal plate.

2. acute form (= suddenly, immediately: less often)
   This leads to a complete detachment of the growth plate (= epiphyseal plate)

3. lenta form (= creeping, delayed: more frequent)
   This leads to an increasing loosening of the epiphyseal plate (= growth plate), which is caused by the slow sliding of the femoral head from the thigh bone

Risk factors

There are no clear risk factors for a Epiphysiolysis capitis femoris define. Nevertheless, it is assumed that a disturbance in the hormonal balance of the growth hormones can largely be made responsible for the development, since this imbalance can in turn cause a disturbance in the area of ​​the growth plate.

The affected children also suffer from excessive weight (= dystrophia adiposogenitalis), delayed sexual maturation or, more rarely, from tall stature, which in turn confirms the importance of hormonal factors.

Cause and course

A distinction is made between the three different forms mentioned above Epiphysiolysis capitis femoris. The acute form, which occurs less frequently than the lenta form, for example, has a less favorable course. In the course of the illness, the sudden occurrence can result in total failure. The affected patients suddenly collapse and are no longer able to walk.

Due to the primarily critical blood supply, which can be seen in the right picture, a femoral head necrosis (= death of the femoral head) can occur due to the complete detachment of the epiphyseal plate. Such femoral head necrosis occurs in about 80% of all cases. The typical Causes of femoral head necrosis are increased alcohol consumption and metabolic disorders.

The course of the Lenta shape is individually different. The course of the disease ranges from complete slipping of the femoral head to complete standstill of the disease. As a rule, the femoral head area near the pelvis remains in the acetabulum, while the femoral neck slides upwards in the area of ​​the growth plate.

clinic

As a rule, adolescent patients complain of knee pain, usually in the knee joint or the front of the thigh. Since these pains often cannot be distinguished from other knee pains, it often takes some time Epipysiolysis capitis femoris initially remains undetected. In the more advanced stage, it is noticeable that patients tire more quickly and suffer from painful restrictions on movement. Ultimately, this also results in an increasing (gentle) limping. In more advanced stages, the disease can also lead to leg shortening and external rotation malalignments (e.g. as part of the flexion process; = positive turning man sign).

diagnosis

As mentioned earlier, it can take weeks or months to draw conclusions about femoral head epipysiolysis from the initial symptoms. The X-ray image is then a diagnostic measure. This is where the sick person becomes hip joint X-rayed using a special imaging technique (= Lauenstein hip imaging) in order to better assess the slipping status. In order to be able to take such an image, the hip must be spread apart by 50 ° (= Abduction) and by 70 ° (= Flexion) can be bent.

In the X-ray image shown above, the red arrows on the respective growth plates. One can see a slight slipping off of the growth plates in the area of ​​the femoral neck (initial stage).

Since the disease very often occurs on both sides, such an exposure is also recommended for the second hip joint.

Under certain circumstances, a MRI (Magnetic resonance tomography).

Classification

The Epipysiolysis capitis femoris is assessed according to the tilting of the femoral head remaining in the pelvis and slipping femoral neck.

How is epiphysiolysis treated? / Therapy

The therapy of Epiphyseal capitis femoris depends on the form of the disease. The extent of the disease is always assessed according to the extent of the tilting of the femoral head that remains in the pelvis and the slipping femoral neck.

In the case of an acute Epiphyseal loosening (acute form), the corresponding hip side must no longer be loaded. With a slight shift, a conservative therapy, the reduction by continuous traction on the affected leg with increasing splay, internal rotation and flexion, should be considered. If the displacement is greater, surgery is usually considered. As a rule, slipping also occurs Hematoma (= Bruise), which is cleared out during the operation. After the reduction, the slipped femoral head is fixed.

Compared to the therapeutic care of the Akuta - Shape of Epiphysiolysis , therapy must be the Lenta - shape of Epiphysiolysis be designed more individually. Surgical therapy always depends on the degree of dislocation:

While a sliding angle in epiphysiolysis up to 30 ° usually supplied with wire pins or screws (see pictures), a femoral neck correction osteoomy (e.g. repositioning operation after Imhäuser) carried out.

It is important to mention that due to the disease and the therapeutic action there is always the risk of developing a circulatory disorder in the femoral neck. This Circulatory disorder can a Hip knock necrosis (= Death of the femoral head) and should be avoided if possible.

Since from the Epiphyseal capitis femoris Both sides of the hip are often affected, it can be considered prophylactically to fix the other side by fixation (possibly screw fixation) as part of the surgical treatment of the slipped side. This could prevent the other side from slipping.

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Treatment by pediatric orthopedists only

IMPORTANT: When a Epiphysliolysis femoral head should always have one Pediatric orthopedist be consulted. Only he can diagnose and treat individually. The information on this page is for information only!

forecast

Important for the prognosis in the event of a present Epiphysliolysis femoral head is that the disease was diagnosed and treated at an early stage. In the case of an early diagnosis with a corresponding operative Correction without further misalignment the prognosis can be described as good, so healing is possible.

However, if healing occurs in the malposition, there is usually a risk of premature wear of the hip joint (= hip joint arthrosis).

A femoral head necrosis has an unfavorable prognostic effect Perthes disease implies.

Furthermore, the occurrence of chondrolysis (= dissolution of hip cartilage; = Waldenström's disease) causes a significantly poorer prognosis.