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Remarks on the etiology and pathogenesis of Perthes' disease: an experiment-based hypothesis
1Katedra i Klinika Ortopedii Dzieciecej i Rehabilitacji Akademii Medycznej im. F. Skubiszewskiego, Lublin.
Insights
Perthes disease in children involves femoral head vascularization issues and bone weakness. Impaired blood flow in growth zones weakens immature bone, potentially causing mechanical damage and disease onset.
Area of Science:
- Pediatric Orthopedics
- Pediatric Radiology
Background:
- Perthes disease etiology involves femoral head vascularization and bone tissue immaturity.
- Mechanical stress on immature bone is a key factor in pathogenesis.
Purpose of the Study:
- To investigate the role of anatomical conditions and growth zone disturbances in Perthes disease.
- To confirm the hypothesis regarding susceptible areas of mechanical stress in the femoral bone.
Main Methods:
- Experimental study using calf femurs as models.
- Radiological assessment of femoral heads in patients with unilateral Perthes disease.
Main Results:
- Immature subchondral bone in the femoral head and neck is most susceptible to mechanical stress.
- Disturbances in epiphyseal growth cartilage and growth plate activity contribute to Perthes disease.
- Radiological abnormalities in asymptomatic contralateral hips suggest temporary blood supply issues.
Conclusions:
- Impaired blood flow in growth layers weakens immature femoral bone, increasing mechanical damage risk.
- Mechanical destruction of blood vessels in immature bone can initiate irreversible Perthes disease.
- Radiological changes in healthy hips are potential risk factors for Perthes disease.
Abstract:
The literature on Perthes' disease points up the significance of specific anatomical conditions affecting vascularization of the femoral head, as well as immaturity and mechanical weakening of the bone tissue in the etiology and pathogenesis of this disorder in children. An experimental study using calf femurs as models confirmed the author's hypothesis that the areas most susceptible to mechanical stress are found in the immature subchondrial layer of the head and neck of the femoral bone. Further investigation of the results suggested that disturbances in the activity of the two growth zones (the epiphyseal growth cartilage and the growth plate) of the proximal femur contribute significantly to the etiology of Perthes' disease. The temporary abnormalities detected radiologically in the healthy femoral heads in about 30% of patients with unilateral Perthes' disease but without clinical symptoms are probably caused by temporary disturbances in the blood supply to these growth layers. These changes are radiological risk factors potentially leading to Perthes' disease. The author concludes that impaired blood flow within the growth layers additionally weakens the immature bone tissue of the femoral head and neck, which may lead to mechanical damage of the bone tissue itself, as well as to the epiphyseal blood vessels entering bony epiphysis. Gradual mechanical destruction of blood vessels in the area of the immature bone tissue below the epiphyseal growth cartilage can eventually initiate the irreversible onset of Perthes' disease.
