Osteochondrosis of the Femoral Head Epiphysis in Children: The Truth You Must Know

Author: Xiao He, attending physician at Nanfang Hospital, Southern Medical University

Reviewer: Wang Jian, Chief Physician, Nanfang Hospital, Southern Medical University

Osteochondrosis of the femoral capital epiphysis is a relatively common disease in children, especially those aged 3 to 10 years. This disease is mainly caused by epiphyseal vascular embolism due to certain factors, which leads to complete or partial necrosis of the epiphyseal ossification center and may be accompanied by endochondral bone disorder. At present, its cause is not completely clear.

1. Does osteochondrosis of the capital femoral epiphysis affect children’s growth and development?

Children's femoral epiphysis osteochondrosis has a certain impact on children's growth and development. Children with the disease will experience pain and limping, their exercise volume will be greatly reduced, and they will be even more reluctant to run and jump, which will slow down the body's metabolism and affect bone growth and development and children's height.

Due to long-term lack of exercise, blood circulation slows down in the affected limbs, leading to malnutrition and muscle atrophy. The femoral shaft bones on the affected side lack nutrition and cannot keep up with the healthy side, resulting in one leg being thicker than the other, and one leg being longer than the other.

Figure 1 Copyright image, no permission to reprint

Therefore, if children receive correct and effective treatment in the early stages of capital femoral epiphysis osteochondrosis, the femur and femoral head on the affected side can develop consistently with the healthy side, leaving no obvious deformity and forming a flat hip, thus not affecting joint movement.

2. Should we choose non-surgical or surgical treatment for children's capital femoral epiphysis osteochondrosis?

The principles of treatment of osteochondrosis of the femoral head epiphysis in children: ① The earlier the treatment, the better; ② No weight bearing. The goal of treatment is to use the acetabulum to form a continuous containment of the femoral head in the early stage to prevent the femoral head from deforming, and to expect to obtain a spherical femoral head and a matching acetabulum during the healing period, that is, "containment treatment". During the fragmentation period, the femoral head is easy to "stick its head out" from the acetabulum and gradually deform under the action of various forces around the hip joint. At this time, appropriate treatment can enable the femoral head to obtain and maintain a spherical contour and smoothly pass through the fragmentation period.

The treatment methods for children's capital femoral epiphysis osteochondrosis are divided into non-surgical treatment and surgical treatment.

1. Non-surgical treatment: mainly includes using braces, plaster, etc. to keep the child's hip joint in abduction position, while resting in bed, strictly prohibiting weight bearing, etc. The child must be checked regularly and wait for the femoral head to recover. If treated early, most children will have a good treatment effect.

Figure 2 Copyright image, no permission to reprint

2. Surgical treatment: Children who are ineffective with non-surgical treatment or who are older or have more severe types of lesions require surgical treatment. The main surgical methods include Salter osteotomy of the pelvis, varus osteotomy of the proximal femur, and triple pelvic osteotomy. During the repair period, the spherical contour of the femoral head is maintained, and the femoral head is kept in the acetabulum to prevent deformation of the femoral head.

The specific treatment method to be used requires the doctor to conduct a comprehensive analysis based on the child's age, gender, clinical symptoms, imaging examinations, etc., and select the appropriate treatment method. No matter which method is used, it is impossible to achieve results overnight. The treatment time must reach 1.0 to 1.5 years to achieve good results. Parents should be reminded that there is currently no specific drug for the treatment of femoral capital epiphyseal osteochondrosis in children, and it has not been proven that traditional Chinese medicine has any benefits in the treatment of this disease.