Epiphysiolysis
An epiphysiolysis ( ancient Greek επίφυσις epiphysis , German 'grown on it' , 'originated'; λύσις lysis , German 'detachment' ; medical: dissolution, detachment) is a detachment of the growth plate with displacement of the epiphysis , which can occur traumatically or without external influence. The latter can occur especially on the hips as an adolescent femoral head solution.
Basics
Epiphysiolysis can only occur as long as the affected bone is not yet fully grown and still has an epiphyseal plate. If part of the epiphyseal plate is already closed, a transitional fracture can occur.
Epiphysiolysis often occurs in connection with injuries to the surrounding bone structures and is divided into different degrees (Aitken 0-IV or Salter -Harris IV), see illustration. The injury of type Aitken IV (Salter-Harris V), not shown, denotes an incomplete or complete compression of the epiphysis, so that the growth potential is disturbed.
As with the other forms, traumatic epiphysiolysis can lead to reduced, increased or partially changed longitudinal growth and thus to later axial misalignments.
therapy
Since the structures that are important for the growth of the bone can be damaged during epiphysiolysis, professional therapy is particularly important in order to avoid later growth errors (incomplete or uneven growth in length).
With the simple forms (Aitken 0 + I or Salter-Harris I + II) , if the dislocation is insignificant, immobilization is sufficient , with the more problematic forms (Aitken II + III or Salter-Harris III + IV), an additional osteosynthesis (e.g. B. with Kirschner wires ). If the epiphyseal plate is axially compressed (Aitken IV), causal therapy is not possible. Despite immobilization, there is usually a delay in growth.
Picture explanation
The left picture shows the fresh epiphysiolysis. The distal (remote from the body, i.e. near the wrist) epiphysis of the radius (spoke) is shifted so that the radius itself is shifted to the palmar (palm side). The arrow in the picture points exactly to the step that was created.
For the inexperienced observer it may be confusing that the spoke and ulna (radius and ulna) lie one behind the other on these images and because of their relative transparency both are visible in the X-ray image.
The right picture shows the situation after the operation. Here, wires (so-called Kirschner wires) were drilled through the epiphysis into the radial shaft from the hand side during the repositioning (bringing it back into position). The radius no longer protrudes to the palmar. The Kirschner wires remain until the epiphysis has grown back in place (2–4 weeks).
Epiphysiolysis in animals
In young dogs, around 30% of all bone fractures are epiphysiolysis, with the upper growth plate of the humerus and the lower thigh bone being most frequently affected. The vast majority are Salter-Harris I or II fractures. The therapy takes place surgically as in humans.
