Synonyms
Juvenile epiphyseal solution, juvenile epiphysiolysis, epiphyseal solution, epiphyseolysis, epiphyseolysis
Definition
Epiphyseolysis capitis femoris is 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 puberty and is seldom acute, but can last for weeks or months.
Age
This disease is a clinical picture of adolescence itself. Therefore, it usually occurs between the age of 9 and the end of growth.
Gender distribution
Boys tend to suffer more frequently from epiphysiolysis. The ratio between male and female is 3:1 and in about 50% of all cases the disease occurs on both sides.
Frequency
The probability of occurrence of this disease is about 1:10000, whereby – as already mentioned – male adolescents are more frequently affected.
Forms
imminens (= threatening) This is an incipient epiphyseal solution which is only recognizable as a loosened epiphyseal joint on X-rays. Acute form (= sudden, immediate: less frequent) This is a complete detachment of the growth plate (= pineal fugue) Lenta form (= creeping, delayed: more frequent) This is an increasing loosening of the pineal fugue (= growth plate), which causes the slow sliding of the femoral head from the femur.
- Imminence (= threatening) This is an incipient epiphyseal solution which is only recognizable as a loosened epiphyseal joint on X-rays.
- Acute form (= sudden, immediate: less frequent) In this case there is a complete detachment of the growth plate (= pineal gland joint)
- Lenta form (= creeping, delayed: more frequent) Here, an increasing loosening of the epiphysis joint (= growth joint) occurs, which is caused by the slow sliding of the femoral head from the thigh bone
Risk factors
No clear risk factors for epiphysiolysis capitis femoris can be defined. However, it is suspected that a disturbance in the hormonal balance of growth hormones may be largely responsible for the development of epiphysiolysis capitis femoris, as this imbalance may in turn cause a disturbance in the growth plate area. The affected children also suffer excessively often from marked overweight (= Dystrophia adiposogenitalis), delayed sexual maturation or, less frequently, also from high growth, which in turn confirms the importance of hormonal factors.
A distinction is made between the three different forms of epiphysiolysis capitis femoris mentioned above. The acute form, which occurs less frequently than the lenta form, for example, has a less favorable course. In the course of the disease, its sudden occurrence can lead to a total loss of function.
The affected patients suddenly collapse and are no longer able to walk. Due to the primarily critical blood supply, which can be seen on the right picture, a femoral head necrosis (= death of the femoral head) can occur due to the complete detachment of the epiphyseal joint. 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 form varies from person to person. Its course ranges from the complete slipping of the femoral head to a complete standstill of the disease. As a rule, the femoral head near the pelvis remains in the acetabulum, while the growth plate of the femoral neck slides upwards.
