yogabuch / pathologie/

Epiphysiolysis capitis femoris / juvenile femoral head dislocation

Definition of

Separation of the epiphysis of the femoral head with subsequent load-related dislocation of the femoral neck relative to the femoral head in ventral, lateral and cranial directions. With an incidence of 10/100,000, a rather rare disorder of the musculoskeletal system during growth. M:W 3:1. eunuchoid tall stature is seen particularly in the context of Klinefelter syndrome. Most cases of epiphyseolysis capitis femoris occur in the context of Fröhlich syndrome, i.e. in obese male patients with developmental delay, but they also occur less frequently independently of this in more asthenic children in the context of certain sports or activities such as long hikes or inline skating. Soccer also often leads to changes in the area of the epiphysis. The sporting activity must be evaluated in the context of these changes.

ICD M93.0

Cause

1. unknown, unclear mismatch between physiologically occurring shear forces and load capacity

Predisposing

1. Reduced antetorsion of the femoral neck
2. Coxa retrotorta ( dorsal rotation of the femoral neck ), therefore reduced antetorsion
3. inclined epiphyseal groove
4. Overweight
5. Pituitary insufficiency
6. Hypothyroidism
7. HGH deficiency
8. Hypogonadism
9. Hormonal disorders during puberty
10. genetic predisposition

Diagnosis

1. X-ray
2. Tests and signs: Drehmann sign

Symptoms

1. Groin pain
2. Knee pain
3. ventral pain in the thigh
4. rarer: hip pain
5. Disturbed gait: exorotated, limping
6. in the acute course: Image of a femoral neck fracture, intolerance of stress, severe pain on movement

Complications

1. FAI (femoroacetabular impingement) with hip endorotation and hip flexion
2. High risk of necrosis of the femoral head
3. Chondrolysis (Waldenström syndrome – not to be confused with Waldenström’s disease)
4. Labrum damage, cartilage degeneration, premature coxarthrosis, need for a TEP

Therapy

1. In acute cases: complete bed rest until the operation
2. OP, various techniques. There is no conservative procedure.