Epiphysis Capitis Femoris: Causes, Symptoms & Treatment

Epiphyseolysis capitis femoris is the name given to an orthopedic condition affecting the hip. It is also known as juvenile femoral head dislocation.

What is epiphyseolysis capitis femoris?

Epiphyseolysis capitis femoris (ECF) involves detachment and slippage of the femoral neck head within the femoral neck growth plate. Because the condition always presents in childhood, it is also known as juvenile femoral head detachment or juvenile epiphyseal detachment. Children between the ages of 10 and 14 are particularly affected by epiphyseolysis capitis femoris. ECF is three times more common in boys than in girls. Many of the affected children are overweight. An acute course of the hip joint disease is rare, so that it usually takes a chronic course. In half of all cases, the head of the femoral neck detaches on both sides of the body. Physicians distinguish between three forms of epiphyseolysis capitis femoris: impending, sudden and gradual ECF. In the impending form, epiphyseal loosening is just beginning. On radiographic examination, only a loosened epiphyseal joint is visible. The sudden acute form occurs only rarely. In this case, the growth plate detaches completely. Most affected children suffer from gradual ECF, in which the femoral head gradually slips off the femur.

Causes

The exact cause of epiphysis capitis femoris has not yet been found. Rather rarely, epiphyseal detachment is caused by an accident. However, in most children there is either overweight or high growth. For this reason, many physicians suspect hormonal disorders as the cause of ECF. Thereby growth hormones have a higher share than the sex hormones. Epiphysis capitis femoris leads to a complete detachment of the epiphyseal joint. Since this provides a connection between the femoral neck and the femoral head, this leads to an impairment of the femoral head blood supply. This increases the risk of femoral head death. While slippage of the femoral neck occurs, the femoral head itself remains in the acetabulum.

Symptoms, complaints, and signs

Typical symptoms of epiphyseolysis capitis femoris include pain in the knee. These show up in the knee joint region or on the front of the thigh. The pain, which tends to be mild, may also occur at the groin. Sometimes there is also a slight shortening of the leg and a limping of the hip. If the hip joint is flexed, internal rotation (inward rotation) is restricted. If epiphyseal loosening is present on both sides of the body, the so-called scissor phenomenon is seen. This means that the lower legs cross each other when bending the knees. If acute ECF occurs, the affected children suffer from considerable pain and abrupt onset of restricted mobility. In most cases, an accident is responsible. If the slipping of the femoral head causes the blood vessels to be severed, there is a risk of femoral head necrosis, in which the hip tissue dies. In addition, the cartilage tissue can perish, which in turn leads to a significant loss of mobility. In both cases, early wear and tear of the joints occurs, which has severely negative effects in children.

Diagnosis

Diagnosing epiphysis capitis femoris is not always easy. The reason for this is the fact that the pain in the knee area often cannot be distinguished from other complaints of this type. Thus, ECF often remains undetected for some time. Only in the later course can evidence of epiphyseal loosening be found. Diagnostic measures include X-ray examination. In this way, a more accurate assessment of the slipped status is possible. For the examination, the patient must flex the hip by 70 degrees and abduct it by 50 degrees. To determine whether the epiphysis is slipping off on both sides of the body, the second hip joint should also be examined. Magnetic resonance imaging (MRI) is sometimes performed to confirm the diagnosis. If ECF is treated in time, it usually takes a positive course. Thus, the disease can heal without malpositions. However, if malalignment occurs, there is a risk of early onset hip joint wear.

Complications

Epiphyseolysis capitis femoris causes severe pain at the knees in most cases.These can occur in the form of pain at rest or pain on exertion. As a rule, this restricts the patient’s movement in everyday life, which is also increased by the shortening of the leg. Pain can also occur in the groin and reduce the quality of life. In the worst case, blood vessels can be severed, resulting in severe restriction of movement. Children in particular are severely affected by epiphyseolysis capitis femoris, as secondary damage can occur in adulthood. In most cases, causal treatment of epiphyseolysis capitis femoris is performed. In this case, acute pain and symptoms can be limited by therapy. However, the affected person must take care of his or her joints and body and must not perform any extraordinary loads. If the bone slips, surgical intervention is usually necessary. This may also involve placing various fixation elements in the knee to allow weight-bearing. After that, in most cases, there are no further complications. However, there is an increased risk that epiphyseolysis capitis femoris will also occur on the second knee.

When should you see a doctor?

If growth disturbances are noticed, a doctor should be consulted. If irregularities occur in the hip region, it is advisable to have them clarified by a doctor. If changes in locomotion are noticed after an accident, these should be examined and treated as soon as possible. In case of movement restrictions, bone changes or pain, medical care is necessary. If gait unsteadiness, coordination problems or a limp occur, there is cause for concern. The general risk of accidents increases and well-being is significantly impaired. A limp should be examined by a physician, as permanent impairments may occur. If muscle discomfort, stiffness or tension occurs, a doctor is needed. Headaches, emotional stress or psychological problems should also be discussed with a doctor. If sleep problems, concentration difficulties, deficits in attention or a noticeable change in mood occur over a longer period of time, these signs should be reported to a doctor. Before taking any medication, it is advisable to consult a medical professional to clarify possible side effects and risks. If stabbing pain occurs during exercise, this is considered extremely unusual. If usual physical activities can no longer be performed, a visit to the doctor is necessary. If bruising or discoloration of the skin repeatedly forms in the hip region, it should be presented to a doctor.

Treatment and therapy

Treatment of epiphyseolysis capitis femoris should be performed by an experienced pediatric orthopedist. Therapy depends on the particular form of the condition present. If it is an acute form of ECF, no further loading of the hip should be allowed. If the displacement is only slight, conservative treatment is sometimes sufficient. This is done by permanent traction of the affected leg. However, if there is extensive displacement, surgery must usually be performed. It is not uncommon for the slippage to cause a hematoma, which is also treated during the operation. After reduction, the surgeon reattaches the femoral head. In most cases, surgical fixation is performed with screws or wire pins. If a larger sliding angle is present, a femoral neck corrective osteotomy often takes place. During surgery, it is also possible to prophylactically fix the second femoral head with screws to counteract its slippage. This is considered important because the risk of epiphyseolysis capitis femoris also occurring on the other side is between 16 and 60 percent. The risk is considered particularly high in girls. However, preventive surgery is not uncontroversial among medical experts. It is important to start therapy as early as possible.

Outlook and prognosis

In epiphyseolysis capitis femoris, the determining factor for the prognosis and course of the disease is the time that elapses before diagnosis and subsequent treatment. The less time that passes, the better the chances of recovery for affected children.Especially in the acute form with a sudden slipping off of the femoral head, a therapy must be carried out quickly and can thus prevent serious late consequences. Other factors that determine the course of a femoral head dislocation include how suddenly the femoral head slips off (acute or chronic form), the angle at which the head slips off the stem, and which therapy procedure was used. The death of the femoral head, the so-called femoral head necrosis, occurs due to a lack of supply to the head. It is probably the most serious complication of epiphyseolysis capitis femoris. However, this can be prevented in many cases by timely surgery. Other consequential damages of epiphyseolysis capitis femoris include arthrosis, which already occurs at a younger age, malpositions in the hip joint and associated complaints such as restricted movement and pain in the affected hip. However, if the disease is diagnosed in time and the hip joint can be operated on without a subsequently persisting deformity, the prognosis of femoral head dislocation is good nowadays.

Prevention

Specific preventive measures against epiphyseolysis capitis femoris are few. For example, it is recommended to avoid obesity and physical overload.

Aftercare

In most cases, there are no special aftercare options available to the person affected by the disease epiphyseolysis capitis femoris. Therefore, first and foremost, the patient must rely on medical examination and treatment of this disease to prevent further symptoms. If left untreated, it may not heal on its own, usually worsening the symptoms. Treatment of epiphyseolysis capitis femoris is usually done with the help of surgical procedures. After such operations, the patient should rest as much as possible and not put unnecessary stress on his body. In particular, stressful or sporting activities should be avoided, and the affected person should ensure strict bed rest. Furthermore, physiotherapy measures often have a positive effect on the course of epiphyseolysis capitis femoris, whereby many of the exercises can also be performed at home. Even after successful treatment, regular examinations by a physician are very useful. In some cases, several surgical interventions are necessary. Loving care and support of the patient also has a positive effect and can possibly alleviate psychological discomfort. As a rule, epiphyseolysis capitis femoris does not reduce the life expectancy of the affected person.

Here’s what you can do yourself

In everyday life, care should be taken to maintain a normal weight. With a healthy and balanced diet, the patient’s weight can be reduced. BMI can be calculated independently and provides information about the range of ideal weight at any age. To support this, it is recommended to promote sufficient exercise in addition to dietary control. Sporting activities support well-being and help with weight reduction. In all physical activities, heavy stress on the bones should be avoided. The hip area in particular should be protected from overuse. In addition, one-sided postures and incorrect stresses should be avoided. Training for a healthy sitting position or training for good posture in all situations can help. Balancing movements and the practice of sports that are considered particularly gentle are helpful. If pain occurs in the hip or knee, adequate rest and protection should be initiated. The joints should be protected from stress and should be cooled immediately with the onset of symptoms. Knee pads or bandages can be applied before sports activities. This provides the knee with additional stability during all movements. Natural healing products can be applied directly to the skin to relieve pain. The use of products containing arnica or aloe vera are recommended.