Diagnosis and Management of Osteonecrosis of the Femoral Head in Young Patients

» Osteonecrosis of the femoral head (ONFH) in pediatric patients is a rare but significant cause of disability because of the risk of early-onset osteoarthritis. The pathophysiology is believed to be vascular in origin, stemming from the friable nature of the epiphyseal blood supply across an open physis. Etiologies of pediatric ONFH include idiopathic, traumatic, and atraumatic. The goal of treatment is to slow disease progression and prevent the sequelae after femoral head collapse. Early diagnosis is key using a combination of physical examination and imaging findings. The management of pediatric ONFH, however, is complicated by a limited body of evidence and a lack of consensus on prevention or treatment. Treatment consideration depends on the age of the patient, extent of femoral head involvement, and presence of femoral head collapse.