Bone Age Delay Patterns in Legg-Calvé-Perthes Disease

Lee, Sung Tae; Vaidya, Sandeep V.; Song, Hae Ryong; Lee, Seok Hyun; Suh, Seung Woo; Telang, Shailendra S.

doi:10.1097/01.bpb.0000242381.89510.e5

Cited by 15 publications

(3 citation statements)

References 27 publications

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“…In a study of 27 girls with LCPD at the time of diagnosis [78], bone age (Tanner Whitehouse 2 method) was delayed an average of 1.4 years for the radius/ulna and 1.9 years for the carpals. A greater delay in bone age is associated with more severe LCPD [79]. Children with transient synovitis show minimal delay in bone age compared to those with LCPD (7 months versus 23 months) [80].…”

Section: Resultsmentioning

confidence: 99%

The Epidemiology and Demographics of Legg-Calvé-Perthes' Disease

Loder

Skopelja

2011

ISRN Orthopedics

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The etiology of Legg-Calvé-Perthes' disease (LCPD) is unknown. There are many insights however from epidemiologic/demographic information. A systematic medical literature review regarding LCPD was performed. The incidence ranges from 0.4/100,000 to 29.0/100,000 children <15 years of age. There is significant variability in incidence within racial groups and is frequently higher in lower socioeconomic classes. The typical age at presentation ranges from 4 to 8 years (average 6.5 years), except for children from the Indian subcontinent (average 9.5 years). There is a mild familial component. The children demonstrate impaired growth in height, skeletal age, and birth weight. This impaired growth coincides with an age appropriate reduced somatomedin A activity and decreased levels of IGF. LCPD can be associated with abnormalities in the coagulation cascade, including an increase in factor V Leiden mutation, low levels of protein C and/or S, and decreased antithrombin activity. There is decreased turnover in type I collagen and synthesis of type III collagen, as well as reduced levels of urinary glycosaminoglycans in the active phases of the disorder. Subtle abnormalities in the opposite hip and other minor/major congenital defects are reported. Children with LCPD are active and score abnormally in certain standardized psychological tests.

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Section: Resultsmentioning

confidence: 99%

The Epidemiology and Demographics of Legg-Calvé-Perthes' Disease

Loder

Skopelja

2011

ISRN Orthopedics

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“…Bone age hand X-ray is relevant as there is a known delay in bone age in PD. 27 The magnitude of this delay at initial infusion and effect of therapy on this delay is recorded.…”

Section: Design and Methodsmentioning

confidence: 99%

Protocol for a randomised control trial of bisphosphonate (zoledronic acid) treatment in childhood femoral head avascular necrosis due to Perthes disease

Jamil

Zacharin

Foster

et al. 2017

bmjpo

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IntroductionPerthes disease (PD) is an idiopathic disorder presenting with avascular necrosis to the femoral head, which frequently results in flattening. Long-term function is directly related to the subsequent femoral head sphericity. Current treatment includes mechanical modalities and surgical procedures, which are therapeutic but are not uniformly able to prevent collapse. The use of the nitrogen-containing bisphosphonate zoledronic acid (ZA) to inhibit osteoclastic bone resorption is aimed at preserving femoral head strength, reducing collapse and thus maintaining shape. The proposed multicentre, prospective, randomised controlled trial intends to evaluate the efficacy of ZA treatment in PD.Methods and analysisAn open-label randomised control trial recruiting 100 children (50 each treatment arm) 5 to 16 years old with unilateral PD. Subjects are randomly assigned to either (a) ZA and standard care or (b) Standard care. The primary outcome measure is deformity index (DI), a radiographic parameter of femoral head roundness assessed at 24 months, following 12 months of ZA treatment (3-monthly doses of ZA 0.025 mg/kg at baseline, 3, 6, 9 and 12 months) plus 12 months observation (group A) or 24 months of observation (group B). Secondary outcome measures are femoral head subluxation, Faces Pain scale, Harris hip score and quality of life. Assessments are made at baseline, 3 monthly during the first year of follow-up and then 6 monthly, until the 24th month.Ethics and disseminationThe study commenced following the written approval from the Human Research Ethics Committee. Safety considerations regarding the effects of ZA are monitored which include the subject’s symptomatology, mineral status, bone mass and turnover activity, and metaphyseal modelling. Data handling plan requires that all documents, clinical information, biological samples and investigation results will be held in strict confidence by study investigators to preserve its safety and confidentiality.Trial registration numberAustralian and New Zealand Clinical Trials ACTRN12610000407099, pre-results.

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“…In many children with proximal femoral pathology the physis is also pathologic. Legg‐Calve‐Perthes disease is a common disease warranting pediatric THA, and is associated with premature femoral growth plate closure, in which the pattern of closure is dependent on the severity and age of diagnosis (Grzegorzewski et al, 2004; Lee et al, 2007). The majority of Legg‐Calve‐Perthes disease are unilateral cases, therefore the contralateral side can be assessed for closure of the proximal femoral physis.…”

Section: Discussionmentioning

confidence: 99%

Prediction of adolescent pelvis development using femoral head and acetabulum growth in a longitudinal radiographic study

Keller

Liu

2020

Clinical Anatomy

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Introduction Adolescent total hip arthroplasty (THA) is guarded partially due unclarity as to when pediatric hip joints reach full development. This study sought to identify when maximum acetabular and femoral head diameters are achieved with relation to chronological and skeletal age. Materials and Methods Consecutive femoral head and acetabular diameters were measured in a random sample of 54 female and 78 male subjects, which were queried from a historical collection of annual radiographs of children. Femoral head and triradiate physeal plates were scored according to Oxford bone parameters. Results At 14 years females had femoral diameters of 4.16 +/− 0.23 cm and acetabular diameters of 5.15 +/− 0.30 cm. At 16 years males had femoral diameters of 4.85 +/− 0.30 cm and acetabular diameters of 5.90 +/− 0.35 cm. In the year following maximal femoral Oxford scores, no significant change was seen in femur and acetabulum diameters in females and in femur diameters in males. In the year following maximal acetabular Oxford scores, there was a significant increase in both femur and acetabulum diameters in both females and males. Conclusions Females on average reach maximum pelvis maturity at 14 years and males reach maximum pelvis maturity at 16 years. A closed femoral head was found to be a good marker of full hip growth, while a closed triradiate was not. This study provides anatomical data for surgeons to consider in assessing risk factors of THA failure in adolescents.

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Bone Age Delay Patterns in Legg-Calvé-Perthes Disease

Cited by 15 publications

References 27 publications

The Epidemiology and Demographics of Legg-Calvé-Perthes' Disease

The Epidemiology and Demographics of Legg-Calvé-Perthes' Disease

Protocol for a randomised control trial of bisphosphonate (zoledronic acid) treatment in childhood femoral head avascular necrosis due to Perthes disease

Prediction of adolescent pelvis development using femoral head and acetabulum growth in a longitudinal radiographic study

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