Abstrakt
V ortopédi sú nozologické jednotky, ktoré sú síce známe a dobre literárne spracované, ale pri klinickej analýze sú zákerné, čo môže vies k nespoznaniu iniciálnej patológie a mylnej diagnóze, ako opisujeme v kazuistike. 
Kazuistika. Na naše pracovisko sa obrátili rodičia za účelom vyšetrenia 11-ročného dievčaťa ako opinio secunda s otázkou, či ide o chorobný proces alebo adolescentnú somatizáciu, dokonca algickú simuláciu bolesti ľavej dolnej končatiny.

Dieťa pred 4 týždňami nešastne zoskočilo z bicykla, podvrtlo si ľavú dolnú končatinu a udrelo ľavé koleno. Odvtedy má bolesť kolena, obmedzenie hybnosti, kríva. Na urgentnom príjme bola dvakrát vyšetrená so záverom bežná kontúzia kolena bez rtg patológie. Na našom pracovisku sme po ortopedickom vyšetrení konštatovali: pôvodná symptomatológia kolena je sekundárna, primárna patológia je v bedrovom kĺbe (epiphyseolysis capitis femoris).
Diskusia. Na prvý pohľad by sa mohlo zda, že ide o simplexnú mylnú analýzu klinickej patogenézy. V našej kazuistike to tak nie je. Epiphyseolysis capitis femoris sa prezentovala typickou zákernosou sekundárnymi symptómami bolesti kolena a poruchou funkcie kolena. Počas 4 týždňov došlo k progresii patológie a prebiehala sanácia epifýzolýzy v dislokovanej polohe s ireverzibilnou patologickou morfológiou. V ortopédii sú kritériá tejto nozologickej jednotky dobre známe.
Záver. Každý úraz v detskom veku si vyžaduje aj dôkladnú klinickú a funkčnú analýzu, ktorú korelujeme so zobrazovacími metódami. Optimálna metóda etiopatogenetickej analýzy je rationatio clinica (clinical reasoning), aby nedošlo k mylnej interpretácii ťažkostí dieťaťa a lokalizácie patologického procesu (obr. 8, lit. 7). Text v PDF www.lekarskyobzor.sk.
KĽÚČOVÉ SLOVÁ: epiphyseolysis capitis femoris, atypická prezentácia bedrovej patológie, Drehmannov test, nešpecifická juvenilná muskuloskeletálna boles, coxa vara adolescentium, sonografia koxy.
Lek Obz 2026, 75 (3): 110-114

Slipped capital femoral epiphysis – unrecognized pathology

Abstract
In orthopedics, certain nosological entities are well described in the literature, yet they may present diagnostic challenges in clinical practice. This can lead to non-recognition of the initial pathology and misdiagnosis, as illustrated in our case report.
Introduction. In orthopedics, there are nosological units that are well known and thoroughly described in the literature, yet they may be diagnostically elusive in clinical analysis. This can result in failure to recognize the initial pathology and lead to misdiagnosis, as demonstrated in the following case report.
Case report. The parents consulted our clinic for a second opinion regarding their 11-year-old daughter, questioning whether her condition represented a disease process, adolescent somatization, or even an algic simulation of pain in the left lower limb. Four weeks earlier, the child had accidentally jumped off a bicycle, sprained her left lower limb, and struck her left knee. Since then, she had experienced knee pain, restricted movement, and limping. She was examined twice in the emergency department, where the diagnosis was a simple knee contusion with no radiographic pathology. At our clinic, following orthopedic examination, we concluded that the original knee symptoms were secondary, and the primary pathology was located in the hip joint – epiphyseolysis capitis femoris.
Discussion. At first glance, this may appear to be a simple diagnostic error in clinical pathogenesis. However, in our case, epiphyseolysis capitis femoris presented with its typical diagnostic ambiguity, manifesting as secondary knee pain and impaired knee function. Over the course of four weeks, the pathology progressed, and the epiphyseolysis evolved into a dislocated position with irreversible pathological morphology. In orthopedics, the diagnostic criteria for this nosological entity are well established.
Conclusion. Every pediatric injury requires thorough clinical and functional analysis, correlated with imaging methods. The optimal approach to etiopathogenetic evaluation is rationatio clinica (clinical reasoning), to avoid misinterpretation of the child’s complaints and to accurately localize the pathological process (Fig. 8, Ref. 7). Text v PDF www.lekarskyobzor.sk.
KEY WORDS: epiphyseolysis capitis femoris, atypical presentation of hip pathology, Drehmann test, nonspecific juvenile musculoskeletal pain, coxa vara adolescentium, hip sonography.
Lek Obz 2026, 75 (3): 110-114 

Jozef VOJTAŠŠÁK 1, Jr., Jozef VOJTAŠŠÁK 1,2 

1 Orthos Paidion, špecializovaná ortopedická ambulancia, Clinica orthopaedica, Bratislava, vedúci prof. MUDr. J. Vojtaššák, CSc.
2 Fakulta ošetrovateľstva a zdravotníckych odborných štúdií SZU, Bratislava, dekanka doc. PhDr. E. Žiaková, PhD.