What to do about ischemic necrosis of the femoral head in children

  Ischemic necrosis of the femoral head in children, often referred to as Perthes’ disease in academic circles, still has an unknown etiology and therefore no effective causal treatment is available. The disease occurs in children between 4 and 7 years of age and has a long natural course, taking 3-6 years from onset to completion of femoral head remodeling. After necrosis of the femoral head, the strength of the support itself will decrease, and the femoral head will be compressed and collapsed after weight-bearing and pressure, followed by mismatch of the head and socket and double-headed deformity, and if the injury (ischemia or bone block compression) involves the epiphysis of the femoral head, it will produce short neck deformity, followed by relative upward displacement of the greater trochanter, manifested by weakness of the gluteal muscles and limited abduction, and painful walking for a long time.  Because of the strong regenerative repair ability of the femoral head in children, the necrosis will show different self-healing abilities, which is obviously related to the age of the child, i.e., the younger children have a higher possibility of self-healing, and boys have a better prognosis than girls. However, we cannot artificially enhance this self-healing ability, and what we can do is the following two main clinical treatments: First, avoid weight bearing to reduce the deformation and compression of the femoral head, resulting in head and socket discomfort and epiphyseal plate injury.  The second is to increase the acetabular inclusion of the femoral head so that the head is remodeled within the acetabulum, thus obtaining a better head and socket match, while the increase in inclusion also helps to reduce the local pressure on the femoral head.  Avoidance of weight bearing can be achieved by simple bed rest, traction, crutches for the affected limb, sciatic brace and external hip brace absences; increasing inclusion can be obtained by both conservative and surgical methods. Conservative methods include abduction of the affected limb and Bay brace, while surgical methods include various pelvic osteotomies and internal femoral osteotomies. Regardless of the treatment method, proper movement of the affected hip is necessary to facilitate both the supply of nutrients to the femoral cartilage and the matching remodeling of the head socket. Our Professor Liu Zhengquan was the first to conduct comprehensive research on this disease in China, and was the first to propose Chiari osteotomy to increase inclusion, achieving better treatment results. Under the guidance of Professor Liu Zhengquan, I have also conducted more in-depth research on this disease, especially in the prevention and treatment of the superior displacement of the greater trochanter, and have published several relevant papers.