Slipped epiphysis in childhood and adolescence.

Hip pain in a young family member, not usually serious, needs urgent X-ray to check for slipped epiphysis and Perthes disease

The more common problem is "transient synovitis" of the hip. This is a sore hip joint from a sprain, often from jumping down off something a bit too far off the ground.

These three hip conditions can cause pain in a young persons' groin, thigh or knee.


SLIPPED CAPITAL FEMORAL EPIPHYSIS

Our "bones" start as pure gristle and gradually turn into hard bone. This process of "ossification" spreads out from two spots, at one end and in the middle.

Eventually nearly all the gristle is replaced by hard bone, leaving only a thin area of cartilage near one end, between the two bony bits.

This plate of gristle is a weak spot, subject to fractures. It is where the slippage occurs.

slipped capital femoral epiphysis

This shows the outlines of the thigh and pelvic bones, as one sees on an X-ray.

The lines of dashes show the slip between the head (top - "capital") and shaft of the thigh bone (femur.)

The gap between C and F is the gristle metaphysis or growth plate.

During growth, bone is added here, pushing the ends apart to lengthen the femur.

Causes of slipped epiphysis are overweight and tissue weakness, both due to diet with too many calories and not enough vitamins and minerals.

The tissue strength depends on collagen synthesis, which in turn depends on adequate supplies of iron, vitamins A and C, zinc, and protein etc.

The amino acids from protein which are most involved, are glycine and proline. Proline can be produced from another amino acid called arginine, which can be used to speed wound healing¹.


LEGG-CALVE-PERTHES DISEASE

Usually just called Perthes disease, when the head of the bone(C) dies.
This is called aseptic necrosis (not obviously caused by infection) or avascular necrosis (mediated by lack of blood supply.)
The cause is unknown².

This is also best treated early, so is another very good reason for an X-ray if a young person has any limp or discomfort in groin, thigh or knee.


TRANSIENT SYNOVITIS OF THE HIP

The hip joint is sore and stiff, and may have been so for weeks. The X-ray is normal.

The child has to rest in bed 24/7, with absolutely no weight bearing. A couple of weeks the they are back to completely normal.


References for slipped epiphysis page

1. A Barbul et al Arginine enhances wound healing and lymphocyte immune responses in humans. Surgery. 1990;108:331–6.

2. From "The Pathology of Perthes Disease" by David G Little, The Children’s Hospital at Westmead

"...what is clear is that the femoral head blood supply is very dependent on the ascending branches of the lateral femoral circumflex (artery,) in turn a branch of profunda femoris (artery.)
A condition very similar but not identical to Perthes can be created in piglets by tying off these and other ascending vessels, along with the repetitive trauma of weight bearing.

In Perthes disease it is well known that the bone age is delayed, an average of 2 years in girls and 1 year in boys. This means the amount of cartilage present in the developing femoral head is larger and the ossific nucleus
smaller.
In one theory these vessels have to traverse a larger than normal cartilaginous anlage to get to get to the epiphysis and are thus vulnerable.

A particular strain of rat called the SHR rat also has a delayed bone age and the onset of a Perthes-like condition occurs in 50% of male rats that stand on their hind limbs to feed. When they are prevented from weight bearing avascular necrosis does not occur."

LINK TO HOME PAGE

LINK TO GROIN PAIN PAGE


Inflammation of the lining membrane of a (synovial) joint is called synovitis.



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Collagen protein is the material of tendons, ligaments and the material between the cells of most tissues, which gives strength and resilience.

The cartilaginous anlage is the forerunner of the final structure - the thigh bone, with head,neck and shaft of bone.

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