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Epiphyseolysis capitis femoris: Klinik, Diagnoseverfahren und Klassifikation

Slipped capital femoral epiphysis: clinical presentation, diagnostic procedure and classification

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Zusammenfassung

Hintergrund

Die Epiphyseolysis capitis femoris (ECF) ist eine häufig chronische und oft bilaterale atraumatische Lösung der proximalen Femurwachstumsfuge in der Adoleszenz. Der Erfolg der Behandlung hängt vom Ausmaß des Abrutsches, dem Erfolg der Therapie sowie von möglichen Komplikationen ab.

Ziel der Arbeit

Überblick zur klinischen Untersuchung und bildgebenden Diagnostik, insbes. zu apparativen Techniken, Messmethoden des Abrutsches und therapierelevanten Klassifikationsschemata.

Material und Methoden

Es handelt sich um einen Überblick zu Klinik, Diagnostik und Klassifikation der ECF auf der Grundlage von Literaturdaten durchgeführter Studien und Erfahrungen unserer klinischen Praxis.

Ergebnisse

Die frühzeitige Diagnose einer ECF ist essenziell: Eine Verzögerung der Diagnosestellung führt regelmäßig zu einer Zunahme des Abrutsches. Dies erhöht das Risiko von Folgeschäden an den zuführenden Blutgefäßen, die zu irreversiblen Gelenkschäden führen können. Symptome und Befunde sind oft subtil und unspezifisch, was in einer Verzögerung in der Diagnostik und Therapie und folglich zur Ausprägung massiver Fehlstellungen resultieren kann. Die Röntgenbildgebung ist die primäre Abbildungsmodalität. Magnetresonanztomographie (MRT), Computertomographie (CT) und Ultraschall können die Bewertung des Schweregrads, der Operationsplanung und der Prognosebewertung unterstützen. Postoperativ liefern sie Informationen zu kurz- und langfristigen Komplikationen.

Diskussion

In der bis heute aktuellen Literatur sowie bei unseren eigenen Patienten ist die Verzögerung in der Diagnostik der ECF weiterhin präsent. Dies zeigt die große Bedeutung einer wiederholten, konsequenten Schulung zu diesem Thema, um Schaden vom Patienten abzuwenden. Wann ein Patient von erweiterten Bildgebungstechniken wie der MRT oder der CT profitiert, ist diskussionswürdig und sollte von Fall zu Fall geprüft werden.

Abstract

Background

Slipped capital femoral epiphysis (SCFE) is a frequent chronic and often bilateral atraumatic slippage of the epiphysis relative to the femoral neck in adolescence. The success of the treatment depends on the extent of the slippage and possible complications.

Objectives

Review on current trends in clinical examination and diagnostic imaging protocols. Commonly used imaging techniques, methods of measuring the slippage and treatment-relevant classification schemes are presented.

Materials and methods

An overview on the clinical findings, the diagnostic procedures and the classification of SCFE based on relevant study results and experience gained in our daily clinical practice.

Results

Early diagnosis of SCFE is essential, as a delay in diagnosis regularly leads to an increase in slippage with an increased risk of subsequent damage to the blood vessels, which can lead to irreversible damage of the joint. Symptoms and findings are frequently subtle and nonspecific, often leading to delay in diagnosis and treatment and, consequently, to the manifestation of massive deformities. X‑ray imaging is the primary imaging modality, whereas MRI, computed tomography (CT) and ultrasound are helpful in surgical planning and prognostic evaluation. Postoperatively, they provide information on short and long-term complications.

Discussion

The delay in the diagnosis of SCFE is still present in the literature as well as in our own patient population, indicating that a repeated, consistent training on this topic is essential to prevent harm to patients. Whether patients benefit from advanced imaging techniques such as MRI or CT is questionable and should be screened case by case.

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Abbreviations

3D:

Dreidimensional

a.-p.:

Anterior-posterior

AVN:

Avaskuläre Nekrose

CT:

Computertomographie

ECF:

Epiphyseolysis capitis femoris

FAI:

Femoroazetabuläres Impingement

MRT:

Magnetresonanztomographie

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Authors and Affiliations

  1. Klinik für Orthopädie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    D. Bittersohl, B. Bittersohl, B. Westhoff & R. Krauspe

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  3. B. Westhoff
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Correspondence to D. Bittersohl.

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D. Bittersohl, B. Bittersohl, B. Westhoff und R. Krauspe 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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Bittersohl, D., Bittersohl, B., Westhoff, B. et al. Epiphyseolysis capitis femoris: Klinik, Diagnoseverfahren und Klassifikation. Orthopäde 48, 651–658 (2019). https://doi.org/10.1007/s00132-019-03767-w

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