Clinic
As a rule, adolescent patients complain of knee pain, usually in the area of the knee joint or the front of the thigh. Since this pain is often indistinguishable from other knee pain, it often takes some time and the epipysiolysis capitis femoris remains undetected at first. In the more advanced stages, it is then noticeable that patients tire more quickly and suffer from painful movement restrictions.
This ultimately results in the increasing (already) limping. In more advanced stages, the disease can also lead to leg shortening and malpositions of external rotation (e.g. during the bending process; = positive rotation sign). As already mentioned, it can take weeks and months before conclusions about epipysiolysis capitis femoris can be drawn from the initial symptoms.
X-ray imaging is then a diagnostic measure. The diseased hip joint is x-rayed using a special imaging technique (= Lauenstein hip x-ray) in order to better assess the slippage status.In order to take such an image, the hip must be spread out by 50° (= abduction) and bent by 70° (= flexion). In the X-ray image above, the red arrows point to the respective growth joints.
A slight slipping of the growth joints in the area of the femoral neck (initial stage) can be seen. Since the disease very often occurs on both sides, such an image is also recommended for the second hip joint. To confirm the diagnosis, an MRI (magnetic resonance imaging) may be consulted under certain circumstances.
Classification
Epipysiolysis capitis femoris is assessed after tilting of the femoral head remaining in the pelvis and slipping neck of the femur. The therapy of epiphyseolysis capitis femoris depends on the form of the disease. The extent of the disease is always assessed according to the degree of tilt of the femoral head remaining in the pelvis and the slipping femoral neck.
In the case of an acute epiphysis solution (acute form), the corresponding side of the hip must not be loaded under any circumstances. If the displacement is minor, a conservative therapy, reduction by continuous traction on the affected leg with increasing abduction, internal rotation and flexion, can be considered. If the shift is more severe, surgery is usually considered.
As a rule, the slippage also causes a hematoma (= bruise), which is removed during the operation. After reduction, the slipped femoral head is fixed. In comparison to the therapeutic treatment of the acute form of epiphysiolysis, the therapy of the lenta form of epiphysiolysis must be designed more individually.
The surgical therapy always depends on the degree of dislocation: While a gliding angle of up to 30° can usually be treated with wire pins or screws (see pictures), a femoral neck correction osteo tomie (e.g. Imhäuser’s corrective surgery) is usually performed for a larger gliding angle. It is important to mention that there is always the risk of a circulatory disorder of the femoral neck due to the disease and the therapeutic action. This circulatory disorder can imply hip knock necrosis (= death of the femoral head) and should be avoided if possible.
Since both sides of the hip are very often affected by epiphyseolysis capitis femoris, it may be considered to prophylactically fix the other side by means of fixation (possibly screw fixation) as part of the surgical treatment of the slipped side. This could prevent the other side from slipping off. –> Back to the main topic Epiphysiolysis
