Epiphysiolysis

Often mistaken for muscle or bone pain, this condition affects children and adolescents between the ages of 11 and 14.

Epiphysiolysis is characterized by the displacement of the femoral neck in relation to the femoral epiphysis—in other words, the slipping of the femoral head within the hip socket. Because it is not widely known, it is often confused with common musculoskeletal pain.

The exact causes of the condition are not fully understood. According to orthopedic specialist Dr. Claudio Santili, epiphysiolysis is often attributed to endocrine imbalances, microtraumas, or obesity. It is believed that the weakening of the growth plate connecting the femoral neck to the epiphysis is most often caused by the action of certain hormones.

“Some body types are more prone to the condition. Overweight children or those who are very thin and tall, who have experienced rapid growth, may have weakened cartilage between the femoral neck and head. When subjected to mechanical stress, they may experience slow or acute slippage,” says Santili.

The most common age range for the condition is between 10 and 14 years for both sexes. “Since epiphysiolysis occurs more frequently during the prepubertal or pubertal period, girls tend to be affected earlier, between ages 10 and 12, and boys between 12 and 14,” explains the orthopedist.

The most common symptoms include: groin pain that may radiate to the inner thigh and knee, an outward rotation of the lower limb while walking, and, the greater the displacement, the greater is the difficulty in hip mobility and pain.

Epiphysiolysis can present acutely or insidiously. In acute cases, the pain is intense and walking becomes difficult. In insidious cases, inflammation occurs, and the pain radiates to the inner thigh and knee, which can easily be mistaken for other everyday injuries, delaying diagnosis. “Epiphysiolysis is a progressive disease, which is why early diagnosis is so important. Doctors should be alert when a child in the prepubertal or pubertal stage complains of lower limb pain and shows outward leg rotation while walking. In such cases, hip mobility should be investigated,” the specialist advises.

Diagnosis is confirmed through a simple pelvic X-ray comparing both sides. If not identified early, epiphysiolysis can lead to serious complications in adulthood, such as hip osteoarthritis and deformities. However, there is no risk of paralysis.

The orthopedist emphasizes that treatment is always surgical. “In simpler cases, epiphysiodesis is performed—a straightforward procedure involving the insertion of a screw between the femoral head and neck. In more severe cases, an osteotomy is recommended, where part of the femur is removed to allow proper repositioning of the femoral head and neck within the acetabular cavity,” the doctor concludes. Physical therapy and water-based exercises are also important to help restore lost mobility.

The orthopedist also highlighted some key points regarding epiphysiolysis. Take note:

• the condition occurs during periods of rapid growth
• initially, pain often radiates to the knee
• a physical exam with the child lying down helps ensure accurate diagnosis
• sophisticated tests are not necessary. A thorough clinical exam and a simple X-ray are sufficient
• when treated in the early stages of slippage, the prognosis is excellent
• complications are part of the natural progression of the disease but can sometimes be triggered by improper maneuvers or interventions
   

By Einstein Editorial Board