Review Article
Volume 13 Issue 8 - 2022
Pediatric Osteonecrosis - Diagnosis, Management and Treatment - For (Legg-Calvé-Perthes; Osgood Schlatter; Sever; and Kohler’s Disease) Suppl I: Overview
Nguyen Ngoc Hung*, Hoang Hai Duc, Le Tuan Anh, Phung Cong Sang and Nguyen Vu Hoang
Pediatric Orthopaedic Department, Vietnam National Hospital for Pediatrics, Vietnam
*Corresponding Author: Nguyen Ngoc Hung, Pediatric Orthopaedic Department, Vietnam National Hospital for Pediatrics, Vietnam.
Received: June 28, 2022; Published: July 28, 2022


Osteonecrosis, also known as avascular necrosis (AVN), aseptic necrosis, or ischemic osteonecrosis, is a disease that results in the death of bone cells.

If this process involves the bones near the joint, it often leads to joint surface collapse and then arthritis due to uneven joint surfaces. Although it can occur in any bone, osteonecrosis most often affects the terminal ends (coccyx) of long bones such as the femur. The bones usually involved are the upper part femur (the ball of the hip socket), the lower femur (part of the knee joint), the upper arm (the upper arm bone in relation to the shoulder joint), and the orbital bone shared fish's eyes. The disease can affect only one bone, multiple bones at once, or multiple bones at different times. Orthopedic surgeons usually diagnose the disease using magnetic resonance X-rays (MRI).

The degree of disability from osteonecrosis depends on which part of the bone is affected, how much of the area is involved, how advanced the disease is, and how well the bone heals itself.

Bone rebuilding occurs after an injury as well during normal growth. Normally, bones are constantly broken down and rebuilt - old bone is reabsorbed and replaced with new bone. This process keeps the skeleton strong and helps it maintain a balance of minerals. With osteosarcoma, the healing process is often ineffective and bone tissues are broken down faster than the body can repair them. If left untreated, the disease progresses and the bones can crack, so the bones can be compressed (collapsed) together (similar to compressing a snowball). If this occurs at the end of the bone, it leads to uneven joint surfaces, joint pain, and loss of function of the affected areas.

Keywords: Pediatric Osteonecrosis; Legg-Calvé-Perthes; Osgood Schlatter; Kohler’s Disease; Avascular Necrosis (AVN)


  1. Lespasio MJ., et al. “Osteonecrosis of the Hip: A Primer”. The Permanente Journal (2019): 23.
  2. Shah KN., et al. “Pathophysiology and risk factors for osteonecrosis”. Current Reviews in Musculoskeletal Medicine3 (2015): 201-209.
  3. Liu Y., et al. “Femoral neck fractures: prognosis based on a new classification after superselective angiography”. The Journal of Orthopaedic Science3 (2013): 443-450.
  4. Mukisi-Mukaza M., et al. “Prevalence, clinical features, and risk factors of osteonecrosis of the femoral head among adults with sickle cell disease”. Orthopedics4 (2000): 357-363.
  5. Pavone V., et al. “Aetiology of Legg–Calvé–Perthes disease: a systematic review”. World Journal of Orthopedics3 (2019): 145-165.
  6. Kuo KN., et al. “Classifcation of Legg–Calvé–Perthes disease”. Journal of Pediatric Orthopaedics2 (2011): S168-173.
  7. Herring JA., et al. “Legg Calve Perthes disease”. Part I: Classifcation of radiographs with use of the modifed lateral pillar and Stulberg classifcations”. Journal of Bone and Joint Surgery American10 (2004): 2103-2120.
  8. Neal DC., et al. “Prevalence of obesity in patients with Legg–Calvé–Perthes disease”. Journal of the American Academy of Orthopaedic Surgeons9 (2016): 660-665.
  9. Kaymaz B., et al. “Neutrophil to lymphocyte ratio may be a predictive marker of poor prognosis in Legg–Calvé–Perthes disease”. HIP International - SAGE Journals6 (2016): 598-601.
  10. Loder RT and Skopelja EN. “The epidemiology and demographics of Legg–Calvé–Perthes’ disease”. ISRN Orthopedics (2011): 1-14.
  11. Ogden JA and Southwick WO. “Osgood–Schlatter’s disease and tibial tuberosity development”. Clinical Orthopaedics and Related Research 116 (1976): 180-189.
  12. Gholve PA., et al. “Osgood Schlatter syndrome”. Current Opinion in Pediatrics1 (2007): 44-50.
  13. Topol GA., et al. “Hyperosmolar dextrose injection for recalcitrant Osgood–Schlatter disease”. Pediatrics5 (2011): e1121-e1128.
  14. El-Husseini TF and Abdelgawad AA. “Results of surgical treatment of unresolved Osgood–Schlatter disease in adults”. Journal of Knee Surgery2 (2010): 103-107.
  15. Eun SS., et al. “Direct bursoscopic ossicle resection in young and active patients with unresolved Osgood-Schlatter disease”. The Arthroscopic Association of North America3 (2015): 416-421.
  16. James AM., et al. “Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial”. British Journal of Sports Medicine20 (2016): 1268-1275.
  17. Bailey CW and Cannon ML. “Sever disease (calcaneal apophysitis)”. The Journal of the American Osteopathic Association5 (2014): 411.
  18. Scharfbillig RW., et al. “Sever's disease: a prospective study of risk factors”. Journal of the American Podiatric Medical Association2 (2011): 133-145.
  19. Hart E., et al. “The Young Injured Gymnast: A Literature Review and Discussion”. Current Sports Medicine Reports11 (2018): 366-375.
  20. Trammell AP and Scott AT. “Kohler Disease”. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing (2020).
  21. Kohler disease.
  22. Riaz S., et al. “Kohler disease: Imaging King Tut’s foot in 21st century”. Journal of Pakistan Medical Association5 (2018): 822.
  23. Aktaş E., et al. “Spontaneous and bilateral avascular necrosis of the navicula: Müller-Weiss disease”. Eklem Hastaliklari ve Cerrahisi3 (2016): 179-182.
Citation: : Nguyen Ngoc Hung., et al. “Pediatric Osteonecrosis - Diagnosis, Management and Treatment - For (Legg-Calvé-Perthes; Osgood Schlatter; Sever; and Kohler’s Disease) Suppl I: Overview”. EC Orthopaedics 13.8 (2022): 47-78.

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