von Stillfried E, Weber M-A
Klinik für Orthopädie und Unfallchirurgie, Zentrum für Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland,
Orthopade. 2014 Aug;43(8):750-7. doi: 10.1007/s00132-013-2227-5.
Aseptic osteonecrosis (AO) in children and adolescents has been described in all parts of the skeleton. The disease is presumed to be caused by local blood circulation disorders, the reasons for which are multifactorial and occur more often in times of stronger growth intensity.
The disease leads to bone catabolism which can affect the epiphyses, metaphyses, apophyses, carpal and tarsal bones of the hands and feet. The more stretched the form alteration of the bone at the end of the diseases is, the earlier arthritic alterations occur due to the incongruence of the corresponding joint partner. If a growth plate is affected, a growth disorder can be the result.
The diagnostics and therapeutic measures are oriented to the site and extent of the disease and the age of the child. For early forms of AO magnetic resonance imaging (MRI) is the imaging method of choice. In recent years the medicinal therapy of AO has been described as an additional option. The disease lasts at least several months up to years and more commonly affects boys than girls with the exception of necrosis of the foot tarsals.
The early diagnosis and immediate initiation of adequate therapy which must take the age and stage of the disease into consideration, can reduce a possible joint destruction. Prostaglandin therapy, as an off label use, leads to a reduction of pain and improvement in mobility.
