In a epiphysiolysis there is a partial or complete slipping of a bone in the growth plate. As a result of this special form of a broken bone, pain occurs in the hip, thigh and knee.
What is epiphysiolysis?
The disease epiphysiolysis is also known as epiphyseal solution. It can be understood as a form of growth disorder. In this case, a defect in the epiphyseal plate of incompletely formed bones occurs mainly as a result of a predisposition.
A traumatic cause can also be held responsible. Epiphysiolysis results in partial or complete detachment of the epiphysis. For this reason, the disease only occurs during puberty. Boys are primarily affected from around the age of 9.
The ratio of sick boys to girls is around 3: 1. The epiphysiolysis almost always develops over weeks or months. Acute detachment occurs rarely. Adolescents who are overweight are primarily affected. Those affected also 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 primarily held responsible. Such a special fracture only occurs in the growing bone because the epiphyseal plates are not yet completely ossified.
For this reason, it is a clinical picture especially of adolescence. The epiphysiolysis therefore develops in the course of adolescence between the age of 9 and the end of growth. In epiphysiolysis, a total of two different disease courses can be distinguished: epiphysiolysis acuta, imminent and lenta.
The former appears very suddenly and the growth plate becomes completely detached. Fewer people are affected by this. The epiphysiolysis lenta, which is determined by a chronic course, occurs much more frequently in adolescents. This is characterized by the fact that the epiphyseal plate loosens gradually. The epiphysiolysis imminens only describes the beginning of the epiphyseal detachment.
Symptoms, ailments & signs
The complaints arise because the displacement of the femoral head in relation to the femoral neck leads to a functional limitation of the hip joint. The extent of the restriction depends on the slip angle. However, typical symptoms always include pain.
These occur primarily in the knee joint area or on the front of the thigh. The diagnosis is often confused with normal knee pain, which is why it often takes some time before epipysiolysis is detected. Only later do those affected suffer from symptoms of fatigue and significant restrictions on movement.
In the advanced stage, relieving posture with a changed gait pattern is therefore one of the typical symptoms. Limping caused by pain is therefore considered a sign. If the disease is very advanced and the femoral head is displaced significantly in the course of the disease, external rotational misalignments and leg shortening can also occur.
Another clinical sign is the so-called positive Drehann sign. In this case, when the hip slips, there is a significant external rotation in the hip joint.
Diagnosis
The clinical picture is often misunderstood at first, so it can take weeks or months before the diagnosis is made. An X-ray image is usually taken to determine this. The so-called Lauenstein hip scan is performed on those affected, with the hip joint being held in a certain position.
This X-ray method allows conclusions to be drawn about the slip status. With this type of exposure, the hip is spread apart by 50 degrees and bent by 70 degrees. The 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 diagnostics, magnetic resonance imaging can also be used.
Complications
As a rule, epiphysiolysis results in severe pain and restricted mobility. These occur mainly in the area of the knees and thighs and can seriously affect the patient’s everyday life. In most cases, the function of the hip joint is severely restricted.
When moving, the person concerned suffers from pain, so that mobility is also restricted. The diagnosis can also be delayed, as the person concerned can often confuse epiphysiolysis with normal knee pain. Likewise, it is no longer possible to carry out sporting activities and strenuous physical work, as these movements are associated with pain.
Typical limping occurs when walking without a walking aid. Due to the restrictions in movement, the person affected can also suffer from depression and other psychological complaints. In most cases, the epiphysiolysis can be treated with the help of surgical interventions, so that the movement restrictions are resolved.
In severe cases, a so-called immobilization is carried out. Life expectancy is not restricted by epiphysiolysis, but there are considerable restrictions in everyday life for the patient, so that he or she may have to rely on the help of other people.
When should you go to the doctor?
Pain in the hips, thighs or legs should be examined and treated by a doctor. If there are restrictions in the range of motion, the symptoms spread or if the gait is unsteady, a doctor should be consulted. Consult a doctor if limping or tilting the body. A poor posture results in permanent skeletal damage without medical care, so that a doctor should be consulted if the posture is abnormal for several weeks.
In the case of muscle complaints, tension or headaches, it is advisable to have the symptoms clarified by a doctor. Before taking any pain medication, it is generally advisable to consult a doctor. Possible risks and side effects associated with taking a preparation can be discussed with him. Problems or bone changes in the joints in the knees should be examined and treated by a doctor.
If symptoms of fatigue, general weakness or a drop in physical performance abilities occur, a doctor should be consulted. If you can no longer take part in normal leisure activities or professional obligations due to the symptoms, a doctor should be consulted. If sleep disturbances, decreased drive or general dissatisfaction occur, a doctor’s visit is necessary as soon as the symptoms persist over a longer period of time.
Treatment & Therapy
In order to avoid consequential damage such as misalignment of the axes 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 there is only a slight shift, conservative therapy is sufficient in some cases. This involves an indirect reduction by pulling the leg with increasing flexion, internal rotation and abduction. If there is a greater shift, surgical treatment usually has to be carried out. A transfixation takes place here.
If the sliding angle is less than 30 degrees, fixation can be carried out with wire pins or screws. An osteotomy is also performed for larger angles of slip over 30 °. This is usually a so-called femoral neck correction osteotomy.
Purely prophylactically, it can make sense to fix the second side of the femoral head at the same time during the operation. This can prevent possible slipping. It is not uncommon for people who develop epiphysiolysis on one side to develop the disease on the other over time. The percentage risk is around 16 to 60 percent.
Outlook & forecast
The prognosis of the epiphysiolysis depends on the severity of the existing impairments. In the case of slight displacement of the bone in the epiphysis, a single correction of the irregularities can already provide lasting relief from the symptoms.
The prospect of recovery is good for patients who have suffered an accident or trauma with slight misalignments. If the symptoms develop within the natural growth and development process, extensive irregularities are often present, which lead to intensive treatment.
In the case of severe impairments and disorders, an operative intervention is carried out. This is associated with the usual risks and side effects. In addition, secondary diseases can occur, which contribute to a worsening of the overall diagnosis. Surgery that has been free of complications goes a long way toward improving health. Usually the bones are artificially fixed so that they cannot slip again.
The musculoskeletal system is trained through specific exercises. This optimizes the general locomotion so that the gait posture and other physical activities can be as symptom-free as possible.
The greater the glide angle, the more complex the medical measures required. In severe cases, irregularities in locomotion remain lifelong. In addition, there is a risk that the disease will develop on the other half of the body over the course of life.
Prevention
Clear prophylactic measures to avoid epiphysiolysis are rather rare. Children and adolescents who are significantly overweight are excessively ill with epiphysiolysis. It is therefore recommended to maintain a normal weight during the growth phase.
Physical overload should also be avoided. People who suffer from delayed sexual maturation or, in rare cases, from tall stature are also primarily affected. Both are due to a hormonal imbalance, which cannot be specifically prevented.
Aftercare
In most cases, the options for follow-up care after an epiphysiolysis are severely limited. The patient is primarily dependent on direct treatment by a doctor in order to completely alleviate the symptoms. As a rule, self-healing cannot occur, so treatment by a doctor is essential.
If the treatment is not carried out or is carried out very late, it can lead to serious complications that can make everyday life difficult for the person concerned. In most cases, this requires surgery. The affected person should rest after this procedure and take care of the body.
Above all, the affected region should be particularly spared. It must not be stressed, whereby the patient is primarily dependent on bed rest. Stressful or sporting activities should be avoided. Since epiphysiolysis can recur even after successful treatment, regular examinations should be carried out.
Physiotherapy measures are also useful to restore the body’s movement. Many exercises can also be done in your own home. Typically, epiphysiolysis does not reduce the patient’s life expectancy.
You can do that yourself
Epiphysiolysis definitely requires medical treatment. With early therapy in a specialist clinic, consequential damage such as axis misalignment or premature joint wear can be avoided. Various home remedies and general measures can be used to accompany medical therapy.
First of all, rest and bed rest, because physical exercise can lead to an increase in the symptoms and promotes the occurrence of the consequential damage mentioned. However, the epiphysiolysis can be treated with specific movement exercises. Those affected should consult a physiotherapist and work out an individual therapy.
An operation is still necessary after the hip bone has slipped. The most important self-help measure after an operation is rest. However, you can start exercising again after a few weeks, as physical exercise in this phase can promote the healing process.
People who suffer from tall stature should always plan the next steps with a specialist in order to avoid a new epiphysiolysis. In general, close monitoring by a doctor is indicated after an operation. Regular check-ups ensure that the hipbone is growing together properly and that there are no undesirable complications.