Epiphysiolysis is a partial or complete slippage of a bone in the epiphyseal joint. As a result of this special type of bone fracture, pain occurs in the hip as well as in the thigh as well as knee.
What is epiphysiolysis?
The condition epiphysiolysis is also known as epiphyseal loosening. It can be understood as a form of growth disorder. In this case, a defect in the epiphyseal groove of incompletely formed bones occurs mainly as a result of a predisposition to the condition. A traumatic cause can also be held responsible. Epiphysiolysis results in a partial or complete detachment of the epiphysis. For this reason, the clinical picture occurs exclusively during puberty. Boys are primarily affected from around the age of 9. The ratio of affected boys to girls is about 3:1. Epiphysiolysis almost always develops over weeks or months. Acute detachment is rather rare. Predominantly affected are adolescents who are overweight. Likewise, affected individuals tend to be tall.
Causes
The exact reasons for the development of epiphysiolysis are not fully known. On the one hand, bone trauma is assumed to be the cause. On the other hand, a genetic predisposition is mainly held responsible. Such a special fracture occurs only in the growing bone, because here the epiphyseal joints are not yet completely ossified. For this reason, it is a clinical picture specific to adolescence. Epiphysiolysis therefore develops during adolescence between the age of 9 and the completion of growth.In epiphysiolysis, a distinction can be made between two different disease processes: Epiphysiolysis acuta, imminens and lenta. The former form occurs quite suddenly and there is a complete detachment of the growth plate. Fewer people are affected by this. Epiphysiolysis lenta is much more common in adolescents and is characterized by a chronic course. This is characterized by a gradual increase in the loosening of the epiphyseal joint. Epiphysiolysis imminens describes only the onset of epiphyseal detachment.
Symptoms, complaints, and signs
Complaints arise because there is a functional limitation of the hip joint due to the displacement of the femoral head relative to the femoral neck. The extent of the restriction depends on the angle of slippage. However, the typical symptoms always include pain. These occur primarily in the knee joint area or at the front of the thigh. There is often diagnostic confusion with normal knee pain, which is why it often takes some time before epipysiolysis is diagnosed. It is only in the later stages that those affected suffer from symptoms of fatigue as well as considerable movement restrictions. In the advanced stage, a relieving posture with altered gait pattern is one of the typical symptoms. A sign of this is the limping caused by pain. If the disease is very advanced and there are major displacements of the femoral head in the course of the disease, external rotation malpositions and leg shortening may also occur. Another clinical sign is the so-called positive torque sign. In this, there is significant external rotation in the hip joint due to slippage during hip flexion.
Diagnosis
The condition is often initially misdiagnosed, so it may take weeks or months to make the diagnosis. An x-ray is usually taken to make the determination. Affected individuals undergo what is known as a Lauenstein hip x-ray, in which the hip joint is held in a specific position. This X-ray procedure allows conclusions to be drawn about the slipped status. During such an x-ray, the hip is spread out by 50 degrees and flexed by 70 degrees. Epipysiolysis often occurs on both sides, which is why the other side of the hip should always be x-rayed as well. Apart from X-ray diagnosis, magnetic resonance imaging may be consulted.
Complications
Usually, epiphysiolysis results in severe pain and limitation of motion. These occur mainly in the knee and thigh areas and can severely affect the patient’s daily life. In most cases, the function of the hip joint is severely restricted.During movement, the affected person suffers from pain, so that mobility is also limited. Diagnosis can also sometimes be delayed, as the affected person can often confuse epiphysiolysis with ordinary knee pain. Likewise, it is no longer possible to perform sports activities and strenuous physical work, as these movements are associated with pain. Walking without a walker results in a typical limp. Due to the restrictions in movement, the affected person may also suffer from depression and other psychological complaints. In most cases, epiphysiolysis can be treated with surgical intervention so that the movement restrictions are resolved. In severe cases, a so-called immobilization is performed. Life expectancy is not limited by epiphysiolysis, but it comes to significant restrictions in everyday life for the patient, so that he may be dependent on the help of other people.
When should you see a doctor?
Pain in the hip, thigh or leg area, should be examined and treated by a doctor. If there are limitations in range of motion, spread of discomfort or unsteadiness in gait, a visit to the doctor should be made. A doctor should be consulted if there is limping or a lopsided posture. Poor posture will result in permanent skeletal damage without medical care, so a doctor should be consulted if posture is noticeable for several weeks. If muscle discomfort, tension or headaches are present, it is advisable to have the symptoms evaluated by a physician. Before taking any pain medication, it is always advisable to consult a physician. With him possible risks and side effects can be discussed, which are connected with the admission of a preparation. Problems or bone changes in the joints of the knees should be examined and treated by a doctor. If symptoms of fatigue, general weakness, or a decrease in physical abilities occur, a physician should be consulted. If the patient is no longer able to perform usual leisure activities or professional duties due to the symptoms, a doctor should be consulted. If sleep disturbances, reduced drive or a general dissatisfaction occur, a visit to the doctor is necessary as soon as the complaints occur over a longer period of time.
Treatment and therapy
To avoid consequential damage such as axial malalignment or a reduction in length growth, professional therapy should be initiated as early as possible. The type of treatment depends on the severity of the disease as well as the present form. In acute epiphysiolysis, immobilization should be initiated immediately. If only a minor displacement is present, conservative therapy is sufficient in some cases. This involves indirect reduction by pulling on the leg with increasing flexion, internal rotation, and abduction. If there is more severe displacement, surgical treatment must usually be performed. In this case, a transfixation is performed. If the slip angle is less than 30 degrees, fixation can be performed with wire pins or screws. If the slip angle is greater than 30°, an osteotomy is also performed. This is usually the so-called femoral neck corrective osteotomy. Purely as a prophylactic measure, it can be useful to fix the second side of the femoral head at the same time during the operation. This can prevent possible slippage. It is not uncommon for individuals who develop epiphysiolysis on one side to also develop it on the other side over time. The percentage risk here is about 16 to 60 percent.
Outlook and prognosis
The prognosis for epiphysiolysis depends on the severity of the existing impairments. In cases of minor displacement of the bone into the epiphysis, a one-time correction of the irregularities may already provide permanent relief of symptoms. The prospect of recovery is favorable in patients of an accident or trauma with slight deformities. If the complaints develop within the natural process of growth and development, there are often extensive irregularities that lead to intensive treatment. In the case of severe impairments and disorders, surgical intervention is performed. This is associated with the usual risks and side effects.In addition, secondary diseases may occur, contributing to a worsening of the overall diagnosis. Surgery that is free of complications contributes significantly to improved health. In most cases, the bones are artificially fixed so that they can be prevented from slipping again. Specific exercises are used to train the musculoskeletal system. This optimizes general locomotion so that gait and other physical activities can be performed with as few complaints as possible. The more severe the slip angle, the more complex the necessary medical measures. In severe cases, locomotion irregularities remain present throughout life. In addition, there is a risk that the disease will also develop on the other half of the body during life.
Prevention
Definite prophylactic measures to prevent epiphysiolysis are rare. Epiphysiolysis disproportionately affects children and adolescents who suffer from significant obesity. Therefore, it is recommended to maintain a normal weight during the growth phase. Physical overload should also be avoided. Also primarily affected are individuals who suffer from delayed sexual maturation or, in rare cases, tall stature. Both are due to a hormonal imbalance, which cannot be specifically prevented.
Aftercare
In most cases, the options for aftercare for epiphysiolysis are severely limited. The patient is primarily dependent on direct treatment by a physician for complete relief of symptoms. As a rule, self-healing cannot occur, so that treatment by a physician is indispensable. If the treatment is not carried out or is carried out very late, serious complications can arise which can make the daily life of the affected person more difficult. In most cases, surgical intervention is required. The affected person should rest and take care of the body after this procedure. In particular, the affected region should be spared. It must not be strained, and the patient is mainly dependent on bed rest. Stressful or sporting activities should be avoided. Since epiphysiolysis can recur even after successful treatment, regular examinations should be performed. Furthermore, physiotherapy measures are also useful in order to restore the body’s movement. Many exercises can also be done at home. As a rule, epiphysiolysis does not reduce the patient’s life expectancy.
Here’s what you can do yourself
Epiphysiolysis definitely requires medical treatment. Early therapy in a specialized clinic can prevent secondary damage, such as axial malalignment or premature joint wear. Accompanying medical therapy, various home remedies and general measures are available. First of all, rest and bed rest are recommended, because physical exercise can lead to an increase in the symptoms and promotes the development of the above-mentioned secondary damage. However, epiphysiolysis can be treated by specific movement exercises. Affected persons should consult a physiotherapist and work out an individual therapy. Surgery is nevertheless necessary after slipping of the hip bone. The most important self-help measure after an operation is rest. However, sports may be started again after a few weeks, as physical exercise can promote the healing process during this phase. Persons suffering from high growth should in any case plan the further steps with a specialist in order to avoid a renewed epiphysiolysis. In general, close monitoring by a physician is indicated after surgery. Regular check-ups ensure that the hip bone grows together properly and that no undesirable complications occur.
