Traumatic epiphysiolysis of the proximal femur

Several former studies show the treatment of slipped epiphysis of the femoral head (SEFH). Its reason is rather unknown. On the other hand the rare traumatic SEFH takes place due to a real accident. According to the literature these injuries are treated like chronic SEFHs. The aim of this study is to show the differences in pathology and treatment of an acute traumatic SEFH in relationship to the chronic SEFH.

In 8 patients dislocated traumatic SEFHs were reduced anatomically and stabilized by the means of 3 to 4 Kirschner- (K-) wires or two cancellous screws. Each patient got a plaster-cast fixation for about 6 weeks of the ipsilateral hip and leg and was mobilized with two crutches and partial weight bearing for 12 weeks. The implants were removed 24 weeks after surgery. Four patients with not dislocated SEFHs were immobilized or mobilized with two crutches without weight bearing according to their pain sensation. The final examination of both groups took place 2 Vz to 15 years after the initial treatment.

Four patients primarily under 10 years of age showed no or minimal radiological signs of a dislocated femoral head and were without any further inconvenience--the suspected SEFHs revealed as hip contusions. 8 children aged 10 years or older at the time of trauma were treated by closed reduction and internal fixation. Complications occurred in three cases--one necrosis of the femoral head because of a perforating K-wire, one subtrochanteric femur fracture after implant removal of a prophylactically stabilized contralateral femoral head and one minimally dislocated femoral head after postoperative too early full weight bearing.

The traumatic SEFH is very different to the chronic one regarding the pathology and acute treatment. Technical challenges must be solved. Unilateral K-wiring or screwing for 24 weeks and reduced weight bearing for the first 12 weeks after surgery is a sufficient way of treatment of the traumatic SEFH.

In the case of a traumatic SEFH it needs to be reduced anatomically and stabilized by surgical means in the acute phase. A prophylactic stabilization of the opposite intact side is usually not required.