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Früh- und Spätkomplikationen sowie deren Management bei der ECF

Early and late complications and their management in slipped capital femoral epiphysis

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Zusammenfassung

Hintergrund

Nach wie vor stellt die Epiphyseolysis capitis femoris (ECF) eine Herausforderung für den behandelnden Arzt dar. Zunächst muss die ECF möglichst frühzeitig diagnostiziert werden. Je früher bei den Heranwachsenden die Diagnose gestellt werden kann, desto geringer ist der Abrutsch. Bei milder ECF werden günstigere Langzeitverläufe beschrieben als bei moderaten oder schweren Abrutschen.

Komplikationen

Mit Zunahme der Abrutsches steigt das Risiko, eine Komplikation zu erleiden. Die Komplikationen der ECF sind vielfältiger Natur, dabei stellen avaskuläre Nekrosen (AVN) und Chondrolysen die schwerwiegendsten Komplikationen dar. AVN treten häufiger bei operierten als bei nichtoperierten Patienten auf. Die instabile ECF hat dabei das größte Risiko, ein AVN zu erleiden.

Therapie

Nach wie vor wird kontrovers über die adäquate Therapie für die instabile ECF diskutiert. Für die operativen Behandlungen werden sehr unterschiedliche Komplikationsraten hinsichtlich der AVN angegeben. Für die Versorgung der Hüftkopfnekrosen gibt es ein breites Spektrum an operativen Therapien, von der hüftgelenkserhaltenden Therapie bis hin zur Hüftendoprothese. Die Versorgung der nicht betroffenen Seite ist in Zentraleuropa weitgehend Konsens, sie ist jedoch nicht komplikationsfrei. Die operative Versorgung mittels In-situ-Pinning muss mit großer Sorgfalt durchgeführt werden, um der Dreidimensionalität des Hüftkopfes Rechnung zu tragen, und um nicht den Hüftkopf zu perforieren. Stets ist darauf zu achten, dass kein Osteosynthesematerial in das Hüftgelenk hinein penetriert.

Abstract

Background

Slipped capital femoral epiphysis (SCFE) remains a challenge for the treating surgeon. First of all, SCFE should be diagnosed as early as possible. The earlier the diagnosis is made in adolescents, the lower the slip angle will be. Mild slips show more favourable long-term courses than moderate and severe SCFE.

Complications

With increasing slip angle, the risk of complications increases. The complications of SCFE are diverse, the most severe of which are avascular necrosis (AVN) and chondrolysis. AVN is more common in surgically treated than in non-operatively managed patients and unstable SCFE bears the highest risk of AVN.

Therapy

Adequate treatment of AVN is still controversial. For surgical treatments, variable rates of AVN have been reported. There is a wide spectrum of surgeries for treating AVN, from hip joint-preserving techniques to total hip replacement. In central Europe there is wide consensus in favour of treating the contralateral side, but this is not without complications. Surgical treatment with in-situ pinning must be carried out with great care to take into consideration the morphology of the femoral head and not to perforate it. It should always be ensured that no osteosynthesis material penetrates the hip joint.

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Abbreviations

ARCO:

Association Research Circulation Osseous

AVN:

Avaskuläre Femurkopfnekrose

CT:

Computertomographie

ECF:

Epiphyseolysis capitis femoris

NMR:

„Nuclear magnetic resonance“

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Authors and Affiliations

  1. Kinder- und Jugendtraumatologie, Orthopädische Klinik, Olgahospital, Klinikum Stuttgart, Kriegsbergsstr. 62, 70174, Stuttgart, Deutschland

    F. F. Fernandez, O. Eberhardt & T. Wirth

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  1. F. F. Fernandez
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  2. O. Eberhardt
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  3. T. Wirth
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Correspondence to F. F. Fernandez.

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F.F. Fernandez, O. Eberhardt und T. Wirth geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Fernandez, F.F., Eberhardt, O. & Wirth, T. Früh- und Spätkomplikationen sowie deren Management bei der ECF. Orthopäde 48, 677–684 (2019). https://doi.org/10.1007/s00132-019-03729-2

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