Conduct treatment of juvenile slipped epiphyses

Abstract

Introduction: mostly occurs in young adulthood. The disease occurs with frequency of 4-5 cases per 100 000 inhabitants, and patients with juvenile slipped epiphyses (JE) represent 0.5-5% of children with orthopedic pathology. The ratio of boys and girls - 3:2. Bilateral involvement is described in 20% of patients. Discussions: JE was described for the first time in 1572. Due to the relative rarity of the disease, many physicians are not aware of the existence of it. Until now the vast majority of children with JE were getting treatment lately. JE etiology is still far from being fully disclosed. The factors are well established: hormonal disorders, genetic predisposition, as well as hard exercises and micro traumas. Endocrine-orthopedic symptom of the disease is the breaking the correlation between sex hormones and growth hormones. Those two groups of hormones play an important role in the development and delayed puberty of the epiphyseal plates. According to some authors the obesity, anteversion on proximal femoral and bones immaturity are the causes of JE. The disease pathogenesis is a slow displacement of proximal femoral epiphysis down and dorsal. With JE the head of the femur remains acetabular fossa, so both femoral neck and femur lose contact with him. This balance is rotating around its longitudinal axis, "flips" to exterior and positions member in the position of external rotation. The clinic is pretty typical and severe form of the disease. The diagnosis is based on anamnesis, clinical examination, orthopedic, X-ray, CT and MRI. Depending on the clinical data, 3 forms of JE are determined: acute, chronic and acute form of the background chronic evolution. R-study must be carried out in two projections: anteroposterior and lateral after Lowenstein - to perform radiometric survey of Klein line. The aim is to obtain treatment of epiphysiodesis: I stage is skeletal traction which ends up with surgery. Conclusions: mandatory consultation at ortoped-pediatric doctor if there are disorders in children walking, pain in the limbs. Benefit of the treatment is directly proportional to the time when the disease was diagnosed. Support of the affected limb is excluded up to 6 months from diagnosis.