[Management of slipped epiphyses in renal osteodystrophy (author's transl)].
Epiphyseal slipping in uraemia differs strikingly from juvenile epiphyseal slipping with respect to pathology and therapy. Based on our own experience with the treatment of 8 uraemic children with epiphyseal slipping, an effort was made to establish the respective indications for conservative and surgical treatment. Mechanical stabilization of slipped epiphyses was achieved within a few weeks without any surgery and usually without parathyreoidectomy by vitamin D3 alone. The initial dose was 10,000 to 30,000 I.U./day, the total curative dose 1.8 to 5.6 millions I.U. Prolonged immobilization was unnecessary. Rising urinary calcium excretion was a valuable indicator of vitamin D intoxication even in advanced renal failure. In one case, pronounced metaphyseal deformations (distal femur, distal tibia) required surgical correction before the ability to walk normally was restored. - The following therapeutical approach is recommended: metabolic bone disease must be cured by vitamin D therapy with or without parathyreoidectomy. Osteotomy to correct metaphyseal deformities or coxa vara epiphysaria never should be performed before metabolic bone disease is healed.
D000293:Adolescent; D002118:Calcium / Q000097:blood / Q000627:therapeutic use / Q000652:urine; D002648:Child; D002675:Child, Preschool; D002762:Cholecalciferol / Q000627:therapeutic use; D004839:Epiphyses, Slipped / Q000097:blood / Q000209:etiology / Q000628:therapy*; D005260:Female; D006621:Hip Joint; D006801:Humans; D007592:Joint Diseases / Q000601:surgery; D008297:Male; D010710:Phosphates / Q000627:therapeutic use; D014511:Uremia / Q000097:blood / Q000150:complications*; D014807:Vitamin D / Q000506:poisoning
D010710:Phosphates; D014807:Vitamin D; D002762:Cholecalciferol; D002118:Calcium
Therapeutische Erfahrungen bei urämischer Epiphysenlösung