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

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.