Clinical outcomes of conservative treatment with a non-weight-bearing abduction brace for Legg–Calvé–Perthes disease

Iwamoto, Miho; Nakashima, Yasuharu; Nakamura, Tomoyuki; Yamaguchi, Ryosuke; Takamura, Kei

doi:10.1016/j.jos.2017.09.012

Cited by 15 publications

(26 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ischemic ON affects a wide age range of patients including children, adolescents, and adults. Numerous studies show that age at onset of ischemic ON is one of the most important predictors of outcome 12‐16 . In Legg‐Calve‐Perthes disease (juvenile idiopathic osteonecrosis of the femoral head), the onset of the disease before 6 years of age is generally associated with a good outcome even without treatment, while age at onset after age nine, especially during teenage years, is associated with a less favorable outcome 12,16,17 .…”

Section: Introductionmentioning

confidence: 99%

Development of a murine model of ischemic osteonecrosis to study the effects of aging on bone repair

Yamaguchi

Kamiya

Kuroyanagi

et al. 2021

Journal Orthopaedic Research

Self Cite

View full text Add to dashboard Cite

Age at onset is one of the most important predictors of outcome following ischemic osteonecrosis (ON). Currently, there is no well‐established animal model to study the effects of age on the repair process following ischemic ON. The purpose of this study was to further advance a murine model of ischemic ON using four age groups of mice to determine the effects of aging on revascularization and bone repair following ischemic ON. Ischemia was surgically induced in the distal femoral epiphysis of four age groups of skeletally immature and mature mice; juvenile (5 weeks), adolescent (12 weeks), adult (22 weeks), and middle age (52 weeks). Mice were euthanized at 2 days or 4 weeks post‐ischemia surgery to evaluate the extent of ON, revascularization, and bone repair. Terminal deoxynucleotidyl transferase‐mediated dUTP nick‐end labeling staining showed extensive cell death in the epiphysis of all four age groups at 2 days post‐ischemia surgery. At 4 weeks, the juvenile mice followed by the adolescent mice had significantly greater revascularization and repair of the necrotic marrow space, increased osteoblast and osteoclast numbers, and increased bone formation rates compared to the adult and middle‐age mice. Faster revascularization and bone healing were observed in the skeletally immature mice compared to the skeletally mature mice following ischemic ON. The findings resemble the clinical observation of aging on bone repair following ischemic ON. The mouse model may serve as a useful tool to investigate the mechanisms underlying the age‐related impairment of bone repair in adolescent and adult ON and to develop novel therapeutic strategies.

show abstract

Section: Introductionmentioning

confidence: 99%

Development of a murine model of ischemic osteonecrosis to study the effects of aging on bone repair

Yamaguchi

Kamiya

Kuroyanagi

et al. 2021

Journal Orthopaedic Research

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, the local non-weight bearing must be prolonged until the advanced stage of revascularization to get the benefit of non-weight bearing. Few clinical studies with prolonged non-weight bearing showed good results of hip and mechanical alignment of the knee [24,25]. In this study, 88.3% of good results (Stulberg I or II) were achieved in children younger than 7 years.…”

Section: The Effect Of Non-weight Bearingmentioning

confidence: 50%

Does early and aggressive management of significant extrusion of the femoral head affect the outcome of Perthes’ disease with the age of onset younger than 7 years?

2021

View full text Add to dashboard Cite

Background Little literature exists regarding aggressive treatment of the extrusion in the early stage of the disease and the outcome at skeletal maturity. The purpose of the study was to evaluate the outcome of the disease with onset younger than 7 years, treated in the early stage of the disease, with aggressive management of significant extrusion (immediate containment with fixed abduction brace in children less than 5 years and varus derotation osteotomy in older children), and reached skeletal maturity. Methods All children with the age of onset younger than 7 years of disease during active Perthes disease were prospectively followed. Children with early stages of the disease (modified Elizabethtown classification) and reached skeletal maturity were included (68 children). The extrusion of the femur head was calculated by Reimer’s migration index on both sides. A migration difference 12 % or above was considered as “significant extrusion”. Children without significant extrusion were treated non-operatively; children with significant extrusion were treated with varus derotation osteotomy. The final radiological outcome was assessed by the Stulberg classification and sphericity deviation score (SDS). The independent “t” test and Chi-square test were done to compare the difference between the two groups. Results The mean age at the onset and the final follow-up was 5.7 years and 15.3 years. The frequency of significant extrusion was 57%. At the final follow-up, an excellent clinical outcome and radiological outcomes (in 88% hips) were noted. There was no significant difference in the Stulberg groups and SDS (sphericity deviation score) in both groups. Conclusion The outcome of the children who had the age of onset of the disease less than 7 years was good with early and aggressive management of the extrusion. The reversal of extrusion is associated with a similar result of non-operative children in this age group. Level of evidence III.

show abstract

“…11,12 Since the healing process against ischemia-induced necrotic bone in Legg-Calvé-Perthes disease and post-traumatic osteonecrosis takes several years, appropriate long-term therapy required. 13,14 MR imaging is useful for early detection of the disease. In particular, contrast enhancement with gadolinium provides precise information about the size of the ischemic area in the femoral epiphysis.…”

Section: Discussionmentioning

confidence: 99%

Subchondral fracture of the femoral head in children: Differential diagnosis of pediatric hip pain

Yamaguchi

Nakamura

Yamamoto

et al. 2020

J Orthop Surg (Hong Kong)

Self Cite

View full text Add to dashboard Cite

This report describes clinical and radiographic characteristics of two pediatric patients with a presumptive diagnosis of subchondral fracture of the femoral head made based on their clinical course and imaging findings. An 8-year-old boy and an 8-year-old girl had subchondral fracture in the femoral head without osteonecrosis, which was verified by contrast-enhanced magnetic resonance imaging. Although complete disappearance of the fracture line was confirmed in the boy, the girl had a residual femoral head deformity after conservative treatment. Subchondral fracture of the femoral head should be included in the differential diagnosis of pediatric hip pain.

show abstract

Clinical outcomes of conservative treatment with a non-weight-bearing abduction brace for Legg–Calvé–Perthes disease

Cited by 15 publications

References 21 publications

Development of a murine model of ischemic osteonecrosis to study the effects of aging on bone repair

Development of a murine model of ischemic osteonecrosis to study the effects of aging on bone repair

Does early and aggressive management of significant extrusion of the femoral head affect the outcome of Perthes’ disease with the age of onset younger than 7 years?

Subchondral fracture of the femoral head in children: Differential diagnosis of pediatric hip pain

Contact Info

Product

Resources

About