Pediatric Femoral Head Osteonecrosis Secondary to Trauma, Sickle Cell Disease, and Corticosteroid Therapy

Abstract

Management of pediatric femoral head osteonecrosis (FHO) due to various etiologies remains a clinical challenge due to delayed diagnosis, limited evidence to guide treatment decision making, and a lack of consensus on treatments to prevent the femoral head deformity. Since many review articles have been written on Legg-Calve-Perthes disease, this review focuses on pediatric FHO secondary to trauma, sickle cell disease, and corticosteroid therapy. Post-Traumatic FHO is a serious complication that can occur following femoral neck fractures and traumatic hip dislocations in children. Sickle cell disease is the most common inherited blood disorder in the US and is a common cause of multi-focal osteonecrosis in patients of African descent and from the sub-Saharan Africa, the Mediterranean, the Persian Gulf, and the Indian subcontinent. Corticosteroid induced osteonecrosis in patients with acute lymphocytic leukemia is of particular interest since acute lymphocytic leukemia is prevalent in the pediatric population. The goal of this review is to educate the clinician on the epidemiology, pathophysiology, natural history, evaluation, and treatment considerations for pediatric FHO secondary to these conditions.

Traumatic Obturator Hip Dislocation in a 9-Year-Old Girl

“…No consensus exists regarding management of pediatric femoral head osteonecrosis after a traumatic hip dislocation. A recent review from the Pediatric Orthopedic Society of North America suggests treatment principles similar to those used in the treatment of Legg-Calve-Perthes disease 14 . The authors recommend weight-bearing restrictions and nonoperative management in younger children and more aggressive operative interventions (core needle decompression, bone marrow aspirate transplantation) in older children.…”

“…Ficat stage III or above), salvage procedures, such as total hip arthroplasty, femoral head wedge resection, and hip fusion, have been proposed. Long-term data (up to 10-year follow-up) have demonstrated excellent outcomes for most of the pediatric patients who undergo successful reduction of a hip dislocation 11,14 .…”

An overview of pathophysiology and treatment options of osteonecrosis of femoral head in sickle cell disease

“…Multiple factors are involved in the onset of atraumatic ON; risk factors exposure (hemoglobinopathy, corticosteroids usage, previous trauma, Gaucher's disease, alcohol consumption or coagulopathies) and genetic predisposition or idiopathic onset. 11,13 The ON event begins with the impaired blood circulation to susceptible articular surfaces occurs repeatedly due to stiffness and abnormality of adherent RBCs, causing bone infarction at epiphyseal plates leading to early degenerative arthritis onset. SCD simultaneously affect multiple joints.…”