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Avascular necrosis of the femoral head in children
Insights
Childhood avascular necrosis (AVN), including Legg-Calvé-Perthes disease and traumatic hip injury, can cause femur growth issues. Early treatment of synovitis and appropriate weight-bearing are key for better outcomes.
Area of Science:
- Pediatric Orthopedics
- Pediatric Radiology
- Pediatric Rheumatology
Background:
- Childhood avascular necrosis (AVN) presents in idiopathic (Legg-Calvé-Perthes disease) and traumatic forms.
- Both types affect the femoral head's blood supply, potentially causing growth disturbances and early degeneration.
- Outcomes depend on patient age, disease severity, and hip joint mechanics.
Purpose of the Study:
- To review the types, outcomes, and management of childhood avascular necrosis.
- To highlight diagnostic and predictive roles of imaging modalities.
- To outline recommended treatment strategies based on AVN type and patient factors.
Main Methods:
- Review of literature on childhood avascular necrosis.
- Discussion of diagnostic tools like bone scans and MRI.
- Analysis of treatment approaches including synovitis management, bracing, and protected weight-bearing.
Main Results:
- AVN can lead to significant proximal femur deformities and early osteoarthritis.
- Imaging techniques like MRI and bone scans aid in diagnosis and prognosis.
- Treatment success is linked to managing synovitis and appropriate joint protection.
Conclusions:
- Prompt treatment of synovitis is crucial for managing childhood AVN.
- Specific interventions like abduction bracing and protected weight-bearing are recommended based on AVN type.
- Long-term outcomes are influenced by early diagnosis, accurate prediction, and tailored management strategies.
Abstract:
Two types of AVN occur in childhood. The first is the idiopathic type best characterized by Legg-Calvé-Perthes' disease associated with repeated infarctions that slow the healing process. The second is the traumatic type caused by a direct insult to the blood supply of the developing femoral head. Both can result in profound growth disturbances of the proximal femur and early degenerative changes. They may have little effect on hip function or appearance. The variables affecting these outcomes are the age of the child, the degree of femoral head involvement, the presence of at-risk signs, the ability of the acetabulum to contain the healing head, and whether or not the growth plate closes as a result of the AVN. Bone scans and magnetic resonance imaging offer some potential for improved accuracy in diagnosis and prediction. The recommendation treatment for AVN in children is to treat the synovitis whenever it occurs or recurs. Abduction bracing should be used for the first six months in most young children with idiopathic AVN of the Legg-Calvé-Perthes' type. Protected weightbearing with crutches should suffice for the early phases of traumatic AVN. Within six months, one should be able to determine the classification and whether to continue the treatment being used or to change to another form of treatment. Petrie casts are used rarely but can be very useful in certain patients. Prolonged crutch use may help to prevent collapse while relieving symptoms in the older child.(ABSTRACT TRUNCATED AT 250 WORDS)