Youth epiphysiolysis of the femoral head and other bones: treatment
What is the epiphysiolysis: symptoms and treatment of an injury
Fractures that affect the region growing plates of bone, called epiphysiolysis.
The growth zone is the cartilage on the end of a long bone and growth plate from which bones grow, adjust their length and shape.
When in adolescence the person completes the maturation of the body, is the closure of the sprout area with the cessation of bone growth. Find plate between the epiphysis (end of the thigh bone) and the metaphysis (advanced bone).
This disease is not observed in adults. This fracture of the exclusive reality of childhood and adolescence, when there are unclosed growing zone that form bone until its closure.
A bit depressing statistics
Almost 30% of children’s fractures have EHBK (epiphysiolysis of the femoral head).
Such bone injuries need immediate medical attention. Otherwise, you can get bone curvature, uneven leg length of the child. Only time prescribed by your doctor, podiatrist treatment will allow to avoid these problems.
Statistics show that the bones are deformed only 1÷10% of children with this disease. Most affected boys, children who are overweight up to obesity.
Found disease in children, adolescents with endocrine disorders, including growth hormone deficiency.
The disease develops in most cases slowly, but can often occur suddenly after an injury, fall.
The cause of trauma
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Still a precise definition of the reasons for the development of epiphysiolysis does not exist.
It is assumed that the cause can be injury, significant physical loads, which negatively affect the condition of certain areas of cartilaginous and bony tissues.
Observations of physicians indicate that there are certain risk groups among children prone to fractures. These include:
- children in puberty, the time of active growth.
- teenagers of the male gender (girls get sick less often);
- adolescents engaged in certain sports — football, volleyball, basketball.
The cause of such fractures fifth of the children be active leisure activities, such as skiing, skating, skateboard, bike.
It is assumed that the cause of the disease can be injuries, significant physical loads, which negatively affect the condition of certain parts of the cartilage and bone tissues.
Classification of the disease
There are several classifications of diseases, the most famous of which is the system of Salter-Harris, dividing the disease into 5 types:
- in type I the fracture line goes across the growing area, causing the whole epiphysis is separated from the bone, and the plate collapses;
- Type II can be found at the line of fracture passing through the growth zone and involving part of the bone body;
- for type III fractures characterized by part-way through the growing zone with simultaneous separation of the epiphysis;
- Type IV damage is diagnosed by fracture lines affecting the germination zone, the body of the bone, the epiphysis;
- Type V fractures are rare or are caused by compression of bone, leading to the crushing sprout album.
What are the bones may suffer
Epiphysiolysis occurs frequently in the following bones of the body:
- The head of the femur. The underlying basis for this disease is the disturbed balance of sexual hormones and responsible
for growth. Pathology appears due to the lack of the first, resulting in growth hormone causes its strengthening. Proximal femur due to this it loses strength, which can cause displacement of the epiphysis.
- In the radius. Epiphysiolysis of the dice becomes possible after injury in the proximal. As a result of damage growing zone, it ceases to develop. Elbow the area continues to grow, so the limb is deformed.
- Tubular bones. Disease of these bones is traumatic or pathological. The first arises due to injury and the second due to the developing pathologies of tubular bones. Bone skin does not lose its integrity. To diagnose the disease is possible only on chest x-ray.
- The bones of the outer ankle. The disease manifests itself in the injury of the tibia in the proximal. This usually happens from autumn to spring, in difficult weather conditions (icy roads, the season of skating and skiing).
Injury in adolescence
Is a rare disease, diagnosed in adolescence.
Youth epiphysiolysis of the femoral head (UEGBK) is offset, a complete separation of the epiphysis in the area of growth plate.
There is an acute or latent bias. The head of the thigh bone due to reduced strength of the growth zone of the epiphysis begins to shift, as if to slip down and back.
The disease is associated with early puberty Teens, when they are actively growing — girls 11 to 12 and boys 13÷14.
Patients UEGBK among children with orthopedic problems, occur with a frequency of about 5 people per 100 thousand cases of the disease, which is 1÷5% in the quantity. But there are exceptions, when the joint affection occurs in an earlier age — 5÷7 years.
About 20% of adolescents have damage to both hip joints, and the manifestations of disease of the second joint is observed after 10 to 12 months.
The clinical picture
Epiphysiolysis does not have any unique symptoms. The clinical picture is determined on the basis of bone fractures:
- pain that increases with the load on the axle;
- bruising on the injured area;
- the occurrence of edema shortly after trauma;
- the limited mobility of the affected limb.
Signs of illness that have arisen not because of an injury and developing of pathological processes in this bone are the following:
- pain in hip, knee joints, and appearing intermittently for several months.
- irregularities in gait, lameness;
- the impossibility of transfer of body weight on the affected leg;
- reversal of the affected limb outwards in comparison with the healthy leg;
- the apparent shortening of the leg.
Diagnosis of injury
The main tools in the diagnosis is the study of the history of the patient, external examination by orthopedic and radiographic examination.
The medical examination can diagnose the disease on the basis of pain arising in large amount of movements of the limbs and an excessive load on it, the appearance of muscle spasms. It is noted the impossibility of folding completely.
X-ray picture is taken in two projections. More information gives you a snapshot in the lateral position.
Judge epiphyses can the course of the line of fracture through the growth zone. The resulting pattern helps to ensure the displacement of the head relative to the femoral neck, which is a confirmation of the disease.
What to do in case of injury?
There are several methods of treatment of epiphysiolysis, which are assigned depending on the type of fracture, degree of displacement of the epiphysis.
The most effective way is surgery.
A method of intra-articular intervention, doctors now suggest, as an open reduction of the femoral head can cause avascular necrosis, a tight joint mobility.
Treatment according to types of fractures are as follows:
- I type. Treated by plaster immobilization, but is more often used surgical method. To recreate normal bone axis is a special pin that will hold the fragments or in the cervix and the head of the femur is entered in the spokes of the period open growing zone. Remove the fixture once the area is closed.
- Type II. Among the most common injuries of this type. Heal well while wearing immobilization bandage of plaster in some cases require surgery with the use of needles, transplants.
- Type III. Characteristic of older children. Required emergency surgery, fixing from the inside to restore the right relationship of the parts of the joint.
- Type IV. These lesions, accompanied by severe displacement of the epiphysis, the end of complete cessation of bone growth. So treat this very quickly. Is closed reposition of fragments by traction of the skeleton for about a month, and then performed osteosynthesis of the head and neck of the femur with spokes and a bone transplant.
- V type. Treatment of such injuries occur by the imposition of plaster bandages, in rare cases, surgery is required.
The goal of treatment is to prevent slipping of the femoral head on, to not give the sprout area to be closed completely.
A further shift can lead to early arthritis, osteoarthritis of the hip joint, restricting its movement.
Therapeutic measures should start almost immediately after diagnosis, what doctors do, by assigning the operation the next day. Speedy diagnostics helps to quickly achieve treatment goals.
The main methods of treatment three, designating one of them is made by the doctor depending on the severity of the disease. These include:
- installation 1 surgical screw through the epiphysis and femoral neck for fixation of the femoral head;
- setting a few screws in the head of the femur with the removal of the offset;
- the removal of growth plate pathology and installing a pin to prevent new displacement.
The complexity of the disease that some children with the condition later comes to the hospital for treatment when a characteristic of the disease strain has a distinct character.
The major complications of late treatment of epiphysiolysis is a full stop growth of the bone in length, the development of the deformation, and as a result, the appearance of asymmetry in older age.
Often leads to the development of necrosis of the head of the thigh bone and chondrolysis.
Necrosis develops due to the fact that the head of the femur due to displacement stops normally supplied with blood. To determine the development of the child almost impossible.
Chondrules, the disease manifested in the loss of the cartilage of the joint, is also considered a complication EGBK. It leads to the fact that loss of motor activity of the joints, not bent, there are pain, marked inflammation.
To restore the range of motion after such complications can taking anti-inflammatory drugs, intense physical therapy.
Prevention of the disease is almost impossible, as a relatively rare disease, not having inherent only in its symptoms, is rarely diagnosed by doctors, in a third of cases are not detected correctly at all.
As a result, the treatment begins in the initial stages, and after months and years.
It is very important after surgery to monitor the baby for about 2 years, to listen to medical recommendations.
In rehabilitation it is necessary to limit physical activity of the child, to exclude sports.
Once a quarter to make a radiograph of the injury, to ensure the closure of the pathological area growth and avoid possible problems. After the closure of the growth zone is fully possible to increase the physical activity of the child.
As the disease occurs only in childhood and adolescence and is rarely seen, parents should pay attention to any problems with the limbs of the child. Easier once again to examine them in the beginning of the disease than to solve problems at an older age, with lower efficiency.