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Skeletal immaturity, rostral sparing, and disparate hip morphologies as biomechanical causes for Legg-Calvé-Perthes’ disease

Berthaume, Michael A.; Perry, Daniel C.; Dobson, Catherine A.; Witzel, Ulrich; Clarke, Nicholas M.; Fagan, Michael J.

Authors

Michael A. Berthaume

Daniel C. Perry

Ulrich Witzel

Nicholas M. Clarke

Abstract

Legg-Calvé-Perthes' (Perthes') disease is a developmental disease of the hip joint that may result in numerous short and long term problems. The etiology of the disease remains largely unknown, but the mechanism is believed to be vascular and/or biomechanical in nature. There are several anatomical characteristics that tend to be prevalent in children with Perthes' disease, namely: skeletal immaturity, reduced height, and rostral sparing. We present an overview of the literature, summarizing the current understanding of the pathogenesis, particularly related to how the formation of the vasculature to the femoral epiphysis places children aged 5–8 at a higher risk for Perthes' disease, how skeletal immaturity and rostral sparing could increase the probability of developing Perthes' disease, and how animal models have aided our understanding of the disease. In doing so, we also explore why Perthes' disease is correlated to latitude, with populations at higher latitudes having higher incidence rates than populations closer to the Equator. Finally, we present five hypotheses detailing how Perthes' disease could have a biomechanical cause. Clin. Anat. 29:759–772, 2016. © 2016 Wiley Periodicals, Inc.

Journal Article Type Article
Publication Date 2016-09
Journal Clinical anatomy
Print ISSN 0897-3806
Electronic ISSN 1098-2353
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 29
Issue 6
Pages 759-772
DOI https://doi.org/10.1002/ca.22690
Keywords Legg-Calve-Perthes disease, Aetiology, Biomechanical causes, Skeletal immaturity, Rostral sparing, Short stature, Allen's and Bergmann's rules, Socioeconomic status, Second-hand smoking, Animal models
Publisher URL http://onlinelibrary.wiley.com/doi/10.1002/ca.22690/abstract
Additional Information Authors' accepted manuscript of article published in: Clinical anatomy, 2016, v.29, issue 6.

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