Talus Osteonecrosis after Chemotherapy: A Case Report.

Area of Science:

• Orthopedics
• Pediatric Oncology
• Radiology

Background:

• T-type acute lymphocytic leukemia (ALL) requires intensive treatment including chemotherapy and glucocorticoids.
• Glucocorticoid therapy is associated with various adverse effects, including avascular necrosis.
• Talus osteonecrosis is a rare but serious complication, particularly in pediatric patients undergoing long-term medical treatment.

Purpose of the Study:

• To describe a rare case of bilateral talus osteonecrosis in a pediatric patient with T-cell ALL.
• To outline the diagnostic process and non-surgical management strategy for this condition.
• To highlight the importance of recognizing avascular necrosis as a potential complication of leukemia treatment.

Main Methods:

• A 13-year-old female with T-cell ALL presented with ankle pain after six months of chemotherapy and glucocorticoid treatment.
• Diagnostic imaging included bone scintigraphy and magnetic resonance imaging (MRI) of both ankles.
• Treatment involved non-surgical management: analgesia, anti-inflammatory drugs, temporary non-weight bearing with an external fixator, and subsequent physical therapy.

Main Results:

• Imaging confirmed avascular osteonecrosis of the bilateral talar body.
• The patient's non-surgical treatment plan, including immobilization and physical therapy, was initiated.
• The patient underwent a course of physical therapy with progressive weight-bearing and pain management.

Conclusions:

• Talus osteonecrosis can occur as a complication in pediatric patients with T-cell ALL undergoing chemotherapy and glucocorticoid therapy.
• Non-surgical management, including pain control, offloading, and rehabilitation, can be a viable treatment option.
• Early diagnosis and appropriate management are crucial for optimizing outcomes in patients with this rare condition.