Intravenous Bisphosphonate Therapy for Traumatic Osteonecrosis of the Femoral Head in Adolescents

Ramachandran, Manoj; Ward, Kate; Brown, R. R.; Munns, Craig; Cowell, Christopher T.; Little, David

doi:10.2106/00004623-200708000-00009

Cited by 49 publications

(43 citation statements)

References 32 publications

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“…The increased attention is most likely related to the fact that osteonecrosis of the femoral head was not reported in the first descriptive studies [13,14,29]. Recent studies, however, have reported that approximately 25% of patients undergoing a modified Dunn for unstable SCFE developed osteonecrosis [21,22]. One of the advantages of the modified Dunn procedure is the ability to perform an intraoperative assessment of epiphyseal perfusion and controlled reduction of the epiphysis preserving its blood supply.…”

Section: Discussionmentioning

confidence: 99%

“…Another potential benefit of intraoperative assessment of perfusion is identification of patients at risk of developing osteonecrosis before radiographic changes take place, which may allow for early interventions to prevent severe deformity secondary to epiphyseal collapse. Complete absence of epiphyseal perfusion (before dissection and after fixation) was highly indicative of osteonecrosis and this may be an indication for further treatment including intravenous bisphosphonates [21].…”

Section: Discussionmentioning

confidence: 99%

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Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

Novais

Sink

Kestel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The modified Dunn procedure, which is an open subcapital realignment through a surgical dislocation approach, has gained popularity for the treatment of unstable slipped capital femoral epiphysis (SCFE). Intraoperative monitoring of the femoral head perfusion has been recommended as a method of predicting osteonecrosis; however, the accuracy of this assessment has not been well documented. Questions/purposes We asked (1) whether intraoperative assessment of femoral head perfusion would help identify hips at risk of developing osteonecrosis; (2) whether one of the four methods of assessment of femoral head perfusion is more accurate (highest area under the curve) at identifying hips at risk of osteonecrosis; and (3) whether specific clinical features would be associated with osteonecrosis occurrence after a modified Dunn procedure for unstable SCFE. Methods Between 2007 and 2014, we performed 29 modified Dunn procedures for unstable SCFE (16 boys, 11 girls; median age, 13 years; range, 8-17 years); two were lost to followup before 1 year. During this period, six patients with unstable SCFE were treated by other procedures. All patients undergoing modified Dunn underwent assessment of epiphyseal perfusion by the presence of active bleeding and/or by intracranial pressure (ICP) monitoring. In the initial five patients perfusion was recorded once, either before dissection of the retinacular flap or after fixation by one of the two methods. In the remaining 22 patients (81%), perfusion was systematically assessed before dissection of the retinacular flap and after fixation by both methods. Minimum followup was 1 year (median, 2.5 years; range, 1-8 years) because osteonecrosis typically develops within the first year after surgery. Patients were assessed for osteonecrosis by the presence of femoral head collapse at radiographs obtained every 3 months during the first year after surgery. Seven (26%) of the 27 patients developed Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. This work was performed at Children's Hospital Colorado, Aurora, CO, USA. osteonecrosis. Mea...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

Novais

Sink

Kestel

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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show abstract

“…(2) Recently, the use of bisphosphonates has been expanding in children and adolescents to treat a variety of pediatric osteopenic conditions, including fibrous dysplasia, traumatic osteonecrosis of the femoral head, disuse osteopenia, and osteogenesis imperfecta (OI). (3)(4)(5)(6) Despite a history of use in adult and pediatric populations, recent complications have led to calls urging caution for longterm bisphosphonate use. Low-energy fractures have been reported in osteoporotic patients treated with bisphosphonates, possibly resulting from reduced remodeling of microdamage in bone (7) or from altered material properties.…”

mentioning

confidence: 99%

Near-infrared fluorescent probe traces bisphosphonate delivery and retention in vivo

Kozloff

Volakis

Marini

et al. 2010

Journal of Bone and Mineral Research

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Bisphosphonate use has expanded beyond traditional applications to include treatment of a variety of low-bone-mass conditions. Complications associated with long-term bisphosphonate treatment have been noted, generating a critical need for information describing the local bisphosphonate-cell interactions responsible for these observations. This study demonstrates that a fluorescent bisphosphonate analogue, far-red fluorescent pamidronate (FRFP), is an accurate biomarker of bisphosphonate deposition and retention in vivo and can be used to monitor site-specific local drug concentration. In vitro, FRFP is competitively inhibited from the surface of homogenized rat cortical bone by traditional bisphosphonates. In vivo, FRFP delivery to the skeleton is rapid, with fluorescence linearly correlated with bone surface area. Limb fluorescence increases linearly with injected dose of FRFP; injected FRFP does not interfere with binding of standard bisphosphonates at the doses used in this study. Long-term FRFP retention studies demonstrated that FRFP fluorescence decreases in conditions of normal bone turnover, whereas fluorescence was retained in conditions of reduced bone turnover, demonstrating preservation of local FRFP concentration. In the mandible, FRFP localized to the alveolar bone and bone surrounding the periodontal ligament and molar roots, consistent with findings of osteonecrosis of the jaw. These findings support a role for FRFP as an effective in vivo marker for bisphosphonate site-specific deposition, turnover, and long-term retention in the skeleton. ß

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“…A number of treatments options were reported for the study population including epiphysiodesis [10,11], pinning in situ (PIS) [1,7,[12][13][14][15][16][17][18][19], closed reduction and pinning (CRIF) [4,5,11,15,16,18,[20][21][22][23][24][25], open reduction and physeal osteotomy (PO) [1,7,15,26] open reduction and internal fixation (ORIF) [23][24][25]27] and surgical dislocation (SD) [13,15,[28][29][30].…”

Section: Description Of Studiesmentioning

confidence: 99%

Evidence based treatment for unstable slipped upper femoral epiphysis: Systematic review and exploratory patient level analysis

et al. 2018

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Intravenous Bisphosphonate Therapy for Traumatic Osteonecrosis of the Femoral Head in Adolescents

Cited by 49 publications

References 32 publications

Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

Is Assessment of Femoral Head Perfusion During Modified Dunn for Unstable Slipped Capital Femoral Epiphysis an Accurate Indicator of Osteonecrosis?

Near-infrared fluorescent probe traces bisphosphonate delivery and retention in vivo

Evidence based treatment for unstable slipped upper femoral epiphysis: Systematic review and exploratory patient level analysis

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