Severe bilateral Legg-Calvé-Perthes resolved with pamidronate in combination with casts, physiotherapy and adductor tenotomy: a pictorial essay over 11 years
We describe an 11-year prospective clinical and radiologic course of a 6-year-old boy with bilateral Legg-Calvé-Perthes disease, who was treated with intravenous pamidronate (IV-PAM). His baseline radiographs showed grade IV avascular necrosis/Catterall stage IV, and at worst he progressed to latera...
Gespeichert in:
| Veröffentlicht in: | BMJ case reports 2019-09, Vol.12 (9), p.e229919 |
|---|---|
| Hauptverfasser: | , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | |
|---|---|
| container_issue | 9 |
| container_start_page | e229919 |
| container_title | BMJ case reports |
| container_volume | 12 |
| creator | Logan, Lindsey Haider, Seemab Brauer, Carmen Miettunen, Paivi Maria |
| description | We describe an 11-year prospective clinical and radiologic course of a 6-year-old boy with bilateral Legg-Calvé-Perthes disease, who was treated with intravenous pamidronate (IV-PAM). His baseline radiographs showed grade IV avascular necrosis/Catterall stage IV, and at worst he progressed to lateral pillar/Herring stage C bilaterally. His disease initially was extremely functionally limiting with expected poor outcome with eventual joint replacement. Because IV-PAM stops bone breakdown and allows for ongoing bone formation while revascularisation of bone occurs, we hypothesised that IV-PAM could act as an adjunct to traditional treatment to help heal the femoral heads. Our patient received nine once monthly doses of IV-PAM (1 mg/kg/dose) over 13 months, along with Petrie/broomstick casts and physiotherapy. Remarkably, over time, his femoral heads healed. Now, at 11-year follow-up, he has excellent functional and radiologic outcome with congruence between femoral head and acetabulum, no residual osteonecrosis and minimal loss of femoral head sphericity. |
| doi_str_mv | 10.1136/bcr-2019-229919 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6754667</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2292772054</sourcerecordid><originalsourceid>FETCH-LOGICAL-b456t-efff1e78d3db01a0e9d05047e39ba95f2612a0c5ee7406a3e778e5e12c5028fe3</originalsourceid><addsrcrecordid>eNqFkc-K1TAUxosozjAza3cScCNiZ_KnaVoXglzUGbigoIK7cNqe3ptL29QkvdKXce9z-GKmdBxGN2aTnJzf-XJOviR5wuglYyK_qmqXcsrKlPOyZOWD5JQpqVJV0q8P751PkgvvDzQuwbIiE4-TE8GkULJQp8mPT3hEh6QyHQR00JEt7nbpBrrjr5_pR3Rhj5449LY7YkO-m7AnI_SmcXaIBcQMpLZ9ZWJg7LDma_DBvyTjfvbGxnoH40xgaAg0zVQH60jAwQbbz68IkNEsVya-jN7DTGzshzBGZgTnz5NHLXQeL273s-TLu7efN9fp9sP7m82bbVplMg8ptm3LUBWNaCrKgGLZUEkzhaKsoJQtzxkHWktEldEcBCpVoETGa0l50aI4S16vuuNU9djUOIT4F3p0pgc3awtG_50ZzF7v7FHnSmZ5rqLA81sBZ79N6IPuja-x62BAO3kdLYogF2pBn_2DHuzkhjjeQnGlOJVZpK5WqnbWe4ftXTOM6sV-He3Xi_16tT9WPL0_wx3_x-wIvFiBqj_8V-03BKy9Xg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2292772054</pqid></control><display><type>article</type><title>Severe bilateral Legg-Calvé-Perthes resolved with pamidronate in combination with casts, physiotherapy and adductor tenotomy: a pictorial essay over 11 years</title><source>MEDLINE</source><source>EZB-FREE-00999 freely available EZB journals</source><source>PubMed Central</source><creator>Logan, Lindsey ; Haider, Seemab ; Brauer, Carmen ; Miettunen, Paivi Maria</creator><creatorcontrib>Logan, Lindsey ; Haider, Seemab ; Brauer, Carmen ; Miettunen, Paivi Maria</creatorcontrib><description>We describe an 11-year prospective clinical and radiologic course of a 6-year-old boy with bilateral Legg-Calvé-Perthes disease, who was treated with intravenous pamidronate (IV-PAM). His baseline radiographs showed grade IV avascular necrosis/Catterall stage IV, and at worst he progressed to lateral pillar/Herring stage C bilaterally. His disease initially was extremely functionally limiting with expected poor outcome with eventual joint replacement. Because IV-PAM stops bone breakdown and allows for ongoing bone formation while revascularisation of bone occurs, we hypothesised that IV-PAM could act as an adjunct to traditional treatment to help heal the femoral heads. Our patient received nine once monthly doses of IV-PAM (1 mg/kg/dose) over 13 months, along with Petrie/broomstick casts and physiotherapy. Remarkably, over time, his femoral heads healed. Now, at 11-year follow-up, he has excellent functional and radiologic outcome with congruence between femoral head and acetabulum, no residual osteonecrosis and minimal loss of femoral head sphericity.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2019-229919</identifier><identifier>PMID: 31537587</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Age ; Bone Density Conservation Agents - administration & dosage ; Bone Density Conservation Agents - therapeutic use ; Case reports ; Casts, Surgical ; Child ; Classification ; Femur Head - drug effects ; Femur Head Necrosis - drug therapy ; Hip Joint - diagnostic imaging ; Hip Joint - pathology ; Humans ; Legg-Calve-Perthes Disease - drug therapy ; Legg-Calve-Perthes Disease - rehabilitation ; Legg-Calve-Perthes Disease - surgery ; Leukemia ; Male ; Medical prognosis ; Novel Treatment (New Drug/Intervention; Established Drug/Procedure in New Situation) ; Pain ; Pamidronate - administration & dosage ; Pamidronate - therapeutic use ; Patients ; Pediatrics ; Physical therapy ; Surgeons ; Surgery ; Tenotomy - methods ; Treatment Outcome ; Twins</subject><ispartof>BMJ case reports, 2019-09, Vol.12 (9), p.e229919</ispartof><rights>BMJ Publishing Group Limited 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2019 BMJ Publishing Group Limited 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>BMJ Publishing Group Limited 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b456t-efff1e78d3db01a0e9d05047e39ba95f2612a0c5ee7406a3e778e5e12c5028fe3</citedby><cites>FETCH-LOGICAL-b456t-efff1e78d3db01a0e9d05047e39ba95f2612a0c5ee7406a3e778e5e12c5028fe3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754667/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6754667/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31537587$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Logan, Lindsey</creatorcontrib><creatorcontrib>Haider, Seemab</creatorcontrib><creatorcontrib>Brauer, Carmen</creatorcontrib><creatorcontrib>Miettunen, Paivi Maria</creatorcontrib><title>Severe bilateral Legg-Calvé-Perthes resolved with pamidronate in combination with casts, physiotherapy and adductor tenotomy: a pictorial essay over 11 years</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><description>We describe an 11-year prospective clinical and radiologic course of a 6-year-old boy with bilateral Legg-Calvé-Perthes disease, who was treated with intravenous pamidronate (IV-PAM). His baseline radiographs showed grade IV avascular necrosis/Catterall stage IV, and at worst he progressed to lateral pillar/Herring stage C bilaterally. His disease initially was extremely functionally limiting with expected poor outcome with eventual joint replacement. Because IV-PAM stops bone breakdown and allows for ongoing bone formation while revascularisation of bone occurs, we hypothesised that IV-PAM could act as an adjunct to traditional treatment to help heal the femoral heads. Our patient received nine once monthly doses of IV-PAM (1 mg/kg/dose) over 13 months, along with Petrie/broomstick casts and physiotherapy. Remarkably, over time, his femoral heads healed. Now, at 11-year follow-up, he has excellent functional and radiologic outcome with congruence between femoral head and acetabulum, no residual osteonecrosis and minimal loss of femoral head sphericity.</description><subject>Age</subject><subject>Bone Density Conservation Agents - administration & dosage</subject><subject>Bone Density Conservation Agents - therapeutic use</subject><subject>Case reports</subject><subject>Casts, Surgical</subject><subject>Child</subject><subject>Classification</subject><subject>Femur Head - drug effects</subject><subject>Femur Head Necrosis - drug therapy</subject><subject>Hip Joint - diagnostic imaging</subject><subject>Hip Joint - pathology</subject><subject>Humans</subject><subject>Legg-Calve-Perthes Disease - drug therapy</subject><subject>Legg-Calve-Perthes Disease - rehabilitation</subject><subject>Legg-Calve-Perthes Disease - surgery</subject><subject>Leukemia</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Novel Treatment (New Drug/Intervention; Established Drug/Procedure in New Situation)</subject><subject>Pain</subject><subject>Pamidronate - administration & dosage</subject><subject>Pamidronate - therapeutic use</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Physical therapy</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Tenotomy - methods</subject><subject>Treatment Outcome</subject><subject>Twins</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkc-K1TAUxosozjAza3cScCNiZ_KnaVoXglzUGbigoIK7cNqe3ptL29QkvdKXce9z-GKmdBxGN2aTnJzf-XJOviR5wuglYyK_qmqXcsrKlPOyZOWD5JQpqVJV0q8P751PkgvvDzQuwbIiE4-TE8GkULJQp8mPT3hEh6QyHQR00JEt7nbpBrrjr5_pR3Rhj5449LY7YkO-m7AnI_SmcXaIBcQMpLZ9ZWJg7LDma_DBvyTjfvbGxnoH40xgaAg0zVQH60jAwQbbz68IkNEsVya-jN7DTGzshzBGZgTnz5NHLXQeL273s-TLu7efN9fp9sP7m82bbVplMg8ptm3LUBWNaCrKgGLZUEkzhaKsoJQtzxkHWktEldEcBCpVoETGa0l50aI4S16vuuNU9djUOIT4F3p0pgc3awtG_50ZzF7v7FHnSmZ5rqLA81sBZ79N6IPuja-x62BAO3kdLYogF2pBn_2DHuzkhjjeQnGlOJVZpK5WqnbWe4ftXTOM6sV-He3Xi_16tT9WPL0_wx3_x-wIvFiBqj_8V-03BKy9Xg</recordid><startdate>20190901</startdate><enddate>20190901</enddate><creator>Logan, Lindsey</creator><creator>Haider, Seemab</creator><creator>Brauer, Carmen</creator><creator>Miettunen, Paivi Maria</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20190901</creationdate><title>Severe bilateral Legg-Calvé-Perthes resolved with pamidronate in combination with casts, physiotherapy and adductor tenotomy: a pictorial essay over 11 years</title><author>Logan, Lindsey ; Haider, Seemab ; Brauer, Carmen ; Miettunen, Paivi Maria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b456t-efff1e78d3db01a0e9d05047e39ba95f2612a0c5ee7406a3e778e5e12c5028fe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age</topic><topic>Bone Density Conservation Agents - administration & dosage</topic><topic>Bone Density Conservation Agents - therapeutic use</topic><topic>Case reports</topic><topic>Casts, Surgical</topic><topic>Child</topic><topic>Classification</topic><topic>Femur Head - drug effects</topic><topic>Femur Head Necrosis - drug therapy</topic><topic>Hip Joint - diagnostic imaging</topic><topic>Hip Joint - pathology</topic><topic>Humans</topic><topic>Legg-Calve-Perthes Disease - drug therapy</topic><topic>Legg-Calve-Perthes Disease - rehabilitation</topic><topic>Legg-Calve-Perthes Disease - surgery</topic><topic>Leukemia</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Novel Treatment (New Drug/Intervention; Established Drug/Procedure in New Situation)</topic><topic>Pain</topic><topic>Pamidronate - administration & dosage</topic><topic>Pamidronate - therapeutic use</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Physical therapy</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Tenotomy - methods</topic><topic>Treatment Outcome</topic><topic>Twins</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Logan, Lindsey</creatorcontrib><creatorcontrib>Haider, Seemab</creatorcontrib><creatorcontrib>Brauer, Carmen</creatorcontrib><creatorcontrib>Miettunen, Paivi Maria</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Logan, Lindsey</au><au>Haider, Seemab</au><au>Brauer, Carmen</au><au>Miettunen, Paivi Maria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Severe bilateral Legg-Calvé-Perthes resolved with pamidronate in combination with casts, physiotherapy and adductor tenotomy: a pictorial essay over 11 years</atitle><jtitle>BMJ case reports</jtitle><addtitle>BMJ Case Rep</addtitle><date>2019-09-01</date><risdate>2019</risdate><volume>12</volume><issue>9</issue><spage>e229919</spage><pages>e229919-</pages><issn>1757-790X</issn><eissn>1757-790X</eissn><abstract>We describe an 11-year prospective clinical and radiologic course of a 6-year-old boy with bilateral Legg-Calvé-Perthes disease, who was treated with intravenous pamidronate (IV-PAM). His baseline radiographs showed grade IV avascular necrosis/Catterall stage IV, and at worst he progressed to lateral pillar/Herring stage C bilaterally. His disease initially was extremely functionally limiting with expected poor outcome with eventual joint replacement. Because IV-PAM stops bone breakdown and allows for ongoing bone formation while revascularisation of bone occurs, we hypothesised that IV-PAM could act as an adjunct to traditional treatment to help heal the femoral heads. Our patient received nine once monthly doses of IV-PAM (1 mg/kg/dose) over 13 months, along with Petrie/broomstick casts and physiotherapy. Remarkably, over time, his femoral heads healed. Now, at 11-year follow-up, he has excellent functional and radiologic outcome with congruence between femoral head and acetabulum, no residual osteonecrosis and minimal loss of femoral head sphericity.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>31537587</pmid><doi>10.1136/bcr-2019-229919</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1757-790X |
| ispartof | BMJ case reports, 2019-09, Vol.12 (9), p.e229919 |
| issn | 1757-790X 1757-790X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6754667 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Age Bone Density Conservation Agents - administration & dosage Bone Density Conservation Agents - therapeutic use Case reports Casts, Surgical Child Classification Femur Head - drug effects Femur Head Necrosis - drug therapy Hip Joint - diagnostic imaging Hip Joint - pathology Humans Legg-Calve-Perthes Disease - drug therapy Legg-Calve-Perthes Disease - rehabilitation Legg-Calve-Perthes Disease - surgery Leukemia Male Medical prognosis Novel Treatment (New Drug/Intervention Established Drug/Procedure in New Situation) Pain Pamidronate - administration & dosage Pamidronate - therapeutic use Patients Pediatrics Physical therapy Surgeons Surgery Tenotomy - methods Treatment Outcome Twins |
| title | Severe bilateral Legg-Calvé-Perthes resolved with pamidronate in combination with casts, physiotherapy and adductor tenotomy: a pictorial essay over 11 years |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T12%3A59%3A01IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Severe%20bilateral%20Legg-Calv%C3%A9-Perthes%20resolved%20with%20pamidronate%20in%20combination%20with%20casts,%20physiotherapy%20and%20adductor%20tenotomy:%20a%20pictorial%20essay%20over%2011%20years&rft.jtitle=BMJ%20case%20reports&rft.au=Logan,%20Lindsey&rft.date=2019-09-01&rft.volume=12&rft.issue=9&rft.spage=e229919&rft.pages=e229919-&rft.issn=1757-790X&rft.eissn=1757-790X&rft_id=info:doi/10.1136/bcr-2019-229919&rft_dat=%3Cproquest_pubme%3E2292772054%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2292772054&rft_id=info:pmid/31537587&rfr_iscdi=true |