Osteochondritis juvenilis
Osteochondritis juvenilis, also known as Legg-Calvé-Perthes disease, is a condition that affects the hip and femur in children, typically between the ages of two and twelve. It involves a disruption of blood supply to the upper part of the thigh bone, leading to impaired bone growth and potential deformity. The exact cause remains unknown, but it may be associated with trauma or damage to the blood vessels supplying the femur. Common symptoms include hip joint tenderness, limping, pain in the thigh or knee, and limited leg movement, often affecting only one leg, which may appear shorter than the other.
Treatment varies based on age and severity; younger children may only need observation, while older children often require more intensive interventions such as physical therapy, braces, or even surgery in severe cases. A Scottish Rite brace is commonly used to hold the legs in position while healing occurs, generally taking about six months. If conservative measures are ineffective or if the child is older, surgical correction may be necessary to reshape the bone or hip socket. Understanding this condition is crucial for parents and caregivers to seek appropriate care and support for affected children.
Osteochondritis juvenilis
ALSO KNOWN AS: Legg-Calvé-Perthes disease, coxa plana, pseudocoxalgia
ANATOMY OR SYSTEM AFFECTED: Hip, femur, musculoskeletal system
DEFINITION: A disturbance of the blood supply to the tops of the thigh bones in children, resulting in impaired bone growth and bone deformity
CAUSES: Unknown; possibly trauma and damage to blood vessels that serve thigh bone
SYMPTOMS: In early stages, tenderness in hip joint, limping, pain in thigh or knee, limited leg movement
DURATION: Chronic
TREATMENTS: Physical therapy, braces and crutches, bed rest with traction
Causes and Symptoms
Osteochondritis juvenilis may be the result of and damage to the blood vessels that serve the bone (femur) in children, aged approximately two to twelve years. The patient, who in the majority of cases is male, usually experiences tenderness in the hip joint area during the early stages of the disease, accompanied by limping, pain in the thigh or knee, and limited movement of the leg. Usually it is difficult to rotate the leg or move it sideways. In 90 percent of cases, only one leg is affected. In such cases, one leg may be shorter than the other, and the child favors the affected leg. If the disease is not treated, of the thigh muscle results.
Treatment and Therapy
Most cases of osteochondritis juvenilis do not require treatment beyond observation, particularly with children under the age of six who have a small amount of damage. For children over six with most of the joint affected, a more aggressive therapy is needed, and older children with the disease are at greater risk for osteoarthritis later in life.
Physical therapy, coupled with braces and crutches or bed rest with traction, is used in the most severe cases. For most children, a Scottish Rite brace is used. Such a brace is belted around the waist and wrapped around the thighs, with a bar holding the knees apart so that the legs are held at a slight angle away from the body. The child wears the brace until the bone heals, usually in about six months.
If the child is more than eight years old, if the brace is too restrictive for an active child, or if the brace must be worn more than six months, surgical correction may be recommended. In these cases, the end of the affected bone is reshaped and the tip of the femur placed back into its socket. Occasionally, the hip socket must be reshaped instead.
Bibliography
Currey, John D. Bones: Structures and Mechanics. 2d ed. Princeton, N.J.: Princeton University Press, 2006.
Kellicker, Patricia Griffin. "Legg-Calve-Perthes Disease." Health Library, May 7, 2013.
Kliegman, Robert M., and Waldo E. Nelson, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia: Saunders/Elsevier, 2011.
"Osteochondritis Dissecans." Mayo Clinic, 25 Aug. 2022, www.mayoclinic.org/diseases-conditions/osteochondritis-dissecans/symptoms-causes/syc-20375887. Accessed 7 Apr. 2024.
Perthes Association. http://www.perthes.org.uk/.
Shapiro, Frederic. Pediatric Orthopedic Deformities: Basic Science, Diagnosis, and Treatment. San Diego, Calif.: Academic Press, 2001.
Staheli, Lynn T. Fundamentals of Pediatric Orthopedics. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2008.
Thomas, Nicholas, et al. "Top 50 Most-Cited Studies about Osteochondritis Dissecans." Arthroscopy, Sports Medicine, and Rehabilitation, vol. 6, no. 2 Feb. 2024, doi.org/10.1016/j.asmr.2023.100859. Accessed 7 Apr. 2024.
Wenger, Dennis R., and Mercer Rang. The Art and Practice of Children’s Orthopaedics. New York: Raven Press, 1993.