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Epiphyseolysis capitis femoris

Slipped capital femoral epiphysis

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Zusammenfassung

Die Epiphyseolysis capitis femoris (ECF) ist eine der häufigsten Hüfterkrankungen beim Heranwachsenden. Falls eine verspätete Diagnose die adäquate Therapie verzögert, können schwerwiegende und an sich vermeidbare Komplikationen auftreten. Die vorliegende Arbeit gibt eine Übersicht über Diagnostik und Therapieoptionen bei der ECF. Bei noch offener Wachstumsfuge am proximalen Femur kommt es im Rahmen der ECF zu einer Verschiebung der Metaphyse im Verhältnis zur Femurkopfepiphyse. Ätiologisch werden verschiedene biomechanische, biochemische und genetische Faktoren untersucht. Die Symptome reichen von plötzlicher Geh- und Stehunfähigkeit bis hin zur vollständigen Abwesenheit von Symptomen. Häufig sind unspezifische Knieschmerzen das einzige Symptom. Die Klassifikation der ECF kann zeitlich (akut, akut auf chronisch oder chronisch), klinisch (stabil, instabil) und radiomorphologisch (milder, moderater und schwerer Abrutsch) erfolgen. Kurzfristige Folgeschäden einer ECF sind avaskuläre Femurkopfnekrose oder Chondrolyse; mittel- und langfristige Folgeschäden sind femoroacetabuläres „impingement“ (FAI) und Coxarthrose. Die kontralaterale Seite ist im Verlauf in 60–80 % der Fälle betroffen und wird in Europa typischerweise prophylaktisch mitbehandelt.

Abstract

Slipped capital femoral epiphysis (SCFE) is one of the most frequent hip disorders in adolescents. In cases of delayed diagnosis and therapy, severe and evitable complications might occur. This article outlines diagnostic tools and therapy strategies for SCFE. With an open proximal femoral physis the metaphysis displaces anterolaterally from the proximal femoral epiphysis. Concerning etiology, several biomechanical, biochemical and genetic factors are under investigation. The clinical presentation ranges from a sudden inability to stand and walk to a complete lack of symptoms. In many cases mild and unspecific knee pain is the only symptom. The classification of SCFE can be temporal (e.g. acute, acute on chronic and chronic), clinical (e.g. stable and unstable) and radio-morphological (e.g. mild, moderate, and severe). Short-term sequelae are avascular necrosis of the epiphysis or chondrolysis, medium and long-term sequelae are femoroacetabular impingement (FAI) and osteoarthritis of the hip joint. The contralateral side is affected in 60–80 % of cases and is usually treated prophylactically at least in Europe.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. C. Zilkens, B. Bittersohl, B. Westhoff, R. Krauspe geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Orthopädische Klinik, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    C. Zilkens, B. Bittersohl, B. Westhoff &  R. Krauspe

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  1. C. Zilkens
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  2. B. Bittersohl
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  3. B. Westhoff
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  4. R. Krauspe
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Correspondence to R. Krauspe.

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Zilkens, C., Bittersohl, B., Westhoff, B. et al. Epiphyseolysis capitis femoris. Monatsschr Kinderheilkd 162, 996–1003 (2014). https://doi.org/10.1007/s00112-013-3026-0

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