Epiphysiolysis: Symptoms and Treatment
Epiphysiolysis is a lesion of the area of the growth plate of the bone. By this area is meant a part of the cartilaginous tissue, which is located on the end of the long bones and constantly develops. The length and shape of the bone in an adult person depends on the formation of the growth plate.
Bones grow from the site of the growth plate. When the body stops developing, this zone closes and the bones stop growing.
Epiphysis is most often formed in children of adolescence. According to statistics, the disease develops in 15-30% of cases, and the patient in this situation needs urgent help from specialists. The recovery period in children is quite fast. But in adults such a disease does not appear at all, since the body is already built and all areas of bone growth are closed.
According to the International Classification of Diseases of the ICD 10, the disease was given the code — M 91-93, depending on the localization of the lesion.
In a group of people who may have the destruction of the epiphysis, include such categories:
- male gender;
- fast growing children
- children involved in outdoor sports — sports, basketball, gymnastics
- excessive mobility on vacation.
The disease can be diagnosed due to traumatic epiphysiolysis, as well as from problems with the endocrine system.
In very young children, the diseases of such a plan do not appear at all, since the main reason for the development of a fracture is an active way of life.
Bone damage can also be caused by genetics and body structure. There were cases in medicine when doctors diagnosed a fracture in too thin and very tall children. Such a pathological effect can be provoked by improper circulation of the head of the bone. For this reason, it becomes fragile and the mineralization process deteriorates.
In adolescence, the ailment progresses from chronic kidney problems, and even if there is a violation of the hormonal background.
According to research, a child can get one of 9 forms of fracture. According to the systematization of Salter-Harris, pathology is divided into the following types:
- I type — a transverse fracture that forms across the entire growth zone, develops in 6% of cases and is characterized by destruction of the epiphyseal plate
- Type II — manifests itself in the growth zone of the damaged part, the metaphysis is slightly affected, but the epiphysis is not damaged, this form occurs in 75% of cases
- Type III — the site of bone damage passes through the growth area without damaging the metaphysis, this type is characterized by the severance of a certain part of the epiphysis and can be diagnosed in 8% of patients
- Type IV — damage extends to both the epiphysis and metaphysis, is formed in 10% of children
- V type — manifested by compression of the bone, occurs in only 1% of cases
This systematization of the disease was supplemented by Rank and Ogden:
- VI type — the peripheral growth area is damaged, which leads to the appearance of bone bridges and angular changes in the limbs
- VII type — isolated damage to the growth area
- VIII type — a fracture in the area of the growth plate with violation of the endochronic growth of the bone, during this process the cartilaginous tissue passes into the bone;
- IX type — the periosteum is damaged, possibly a violation of the structure of ossification.
Such a pathogenic disease can develop in any area of the body where there are growing bones. Quite often, fractures occur in the humerus, tibia, cervix and femur head, external ankle, radius, tubular bones.
Youthful epiphysis of the head of the femur can be noted in the chronic and acute stage. In this case, the degree of impaired functionality of the joint can be light, medium and heavy. The displacement of the epiphysis posterior can also be in 3 forms:
- light — up to 30 degrees;
- Medium — up to 50 degrees;
- Heavy — more than 50 degrees.
Traumatic epiphysis is not developed in the characteristic symptomatology. A child at the moment of a fracture complains about such manifestations:
- pain syndrome, which progresses with an axle load
- a hematoma appears on the affected area
- puffiness is formed after a certain time after injury;
- low activity of the injured limb
The clinical picture can also manifest itself not from getting an injury, but at the appearance of a pathological process in the bone itself. Then the patient may have this symptomatology:
- pain in the hip and knee joints that are periodic in nature
- disturbed gait, there is lameness
- The painful leg unfolds outwards
- Noticeable shortening of the lower limb.
In certain cases of progression of the disease, the patient may have stretch marks, atrophy of the calf and buttocks muscles, and increase the value of blood pressure.
Diagnosis of juvenile epiphysis of the head of the thigh should be an experienced trauma doctor. In the study, the doctor needs to collect an anamnesis, determine the clinical picture and send the patient to the examination. You can recognize the ailment with instrumental diagnostics:
To conduct laboratory research, the doctor must have good reasons, for example, suspicion of the formation of a disease due to hormonal imbalance.
After the diagnosis of «epiphysis of the outer ankle» or «neck of the thigh bone», the patient is prescribed therapy. Treatment of a doctor is prescribed only after the type of injury and stage are identified. The best way to eliminate the cause of damage and symptoms is surgical intervention.
To date, doctors do not use intra-articular technology of surgery in the therapy of an ailment, as directing the femoral head in an open way can provoke aseptic necrosis, complicated joint mobility.
If you need to eliminate epiphysis of the radius or in any other area, doctors immediately rely on the type of diagnosed fracture. Thus, patients are treated in such ways:
- 1 type — the patient is made gypsum immobilization, surgical treatment is often used; To recreate the previous state of the osseous axis, the child is equipped with a special pin to hold the fragments, or they introduce needles into the neck and thigh head, all surgical instruments are removed after the fusion of the zone;
- type 2 — recovery occurs rather quickly with the aid of an immobilization bandage on a gypsum basis, surgery is rarely performed with knitting needles or grafts
- Type 3 — damage to this form is often found in adolescents, and the patient needs urgent surgical care, parts of the joint are fixed from the inside with special tools
- type 4 — the removal of the completely displaced epiphysis is carried out exclusively by the operative method, the patient is subjected to a closed reposition of the parts by stretching the skeleton, and then the doctors perform the osteosynthesis of the head and neck of the thigh with the use of spokes and graft
- Type 5 — therapy is performed by applying bandages on a gypsum base, very rarely using immediate help.
By providing the patient with prompt help, doctors set a goal to further reduce and prevent a femoral head fracture, so that the growth area does not completely close.
If you do not start in time to eliminate the epiphysis of the femoral head, then soon the displacement can only progress and the full stop of the growth of the damaged bone will begin. This threatens the appearance of asymmetry of the lower limbs in adulthood. Also, untimely therapy of the disease can lead to necrosis and chondrolisis.
Today, the only measure to prevent juvenile epiphysis of the head of the femoral or humerus is to reduce trauma. Physical activity should be in moderation. Also, parents should monitor the health of the child and, with the slightest problem, seek medical help.