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  • Title: [Late results of traumatic separation of the upper femoral epiphysis as an obstetrical lesion (author's transl)].
    Author: Baumgartner R, Ruetsch H, Mohler J.
    Journal: Z Orthop Ihre Grenzgeb; 1980 Oct; 118(5):698-707. PubMed ID: 7467716.
    Abstract:
    Publications on birth-traumatic epiphyseolysis of the head of the femur are rare. No long-term reports (the course of the disease extending over 10 years and more) have been published. We must mention the detailed paper published by Mau in 1975 on epiphyseolysis of the head of the femur in children, among which a lesion of the epiphysis in an otherwise complicationfree birth is described. In most of the cases, however, epiphyseolysis occurs with breech presentation (Michail 1958, Mortens 1964), less frequently with Caesarean sections (Baumgartner 1961) and internal versions (Lindseth 1971). If the region of the hip joint appears swollen, associated with haematoma and pain on pressure-which can also occur in the region of the proximal femur, associated with shortening of the leg-then epiphyseolysis must be suspected. Clinical examination of the hip joint is characterized by pain inhibition. X-ray examination of the pelvis ante partum will mostly show lateral and cranial dislocation of the proximal shaft of the femur. Differential diagnosis of a dislocation of the hip joint is possible since symmetrical and well developed acetabulae are present. Diagnosis is finally established by means of arthrography of the hip. Likewise, callus formation supplies proof of the reparation processes subsequent to epiphyseolysis. Treatment in congenital that prescribed by the treatment guidelines in congenital hip dislocation. Abduction-extension is the method of choice. In order to improve reposition of the fragments, an additional internal rotary traction or transverse traction in the direction of adduction is recommended. However, in view of the rapidity of callus formation (approximately 2 weeks) and consolidation of epiphyseolysis, the effectivity of prolonged therapeutic efforts must be doubted if seen in retrospect. This applies mainly to subsequent Lorenz plaster-casts followed by the application of a splint. Several months will elapse until the child begins to stand and to walk, and during this period consolidation of the lysis may have easily taken place.
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