title: Skeletal immaturity, rostral sparing, and disparate hip morphologies as biomechanical causes for Legg-Calvé-Perthes' disease.
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.
authors.affiliation: Medical and Biological Engineering Research Group, School of Engineering, University of Hull, Hull, East Yorkshire, HU6 7RX, United Kingdom.|Department of Anthropology, University of Massachusetts, Amherst, Amherst, Massachusetts.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Berthaume
authors.affiliation: Institute of Translational Medicine, University of Liverpool, Liverpool, L12 2AP, UK.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Perry
authors.affiliation: Medical and Biological Engineering Research Group, School of Engineering, University of Hull, Hull, East Yorkshire, HU6 7RX, United Kingdom.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Dobson
authors.affiliation: Research Group of Biomechanics, Department of Engineering, University of Bochum, Bochum, 44801, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Witzel
authors.affiliation: Department of Child Health, Southampton General Hospital and University of Southampton, Southampton, SO16 6YD, United Kingdom.
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Clarke
authors.affiliation: Medical and Biological Engineering Research Group, School of Engineering, University of Hull, Hull, East Yorkshire, HU6 7RX, United Kingdom.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fagan
mesh_terms: D000818:Animals; D004838:Epiphyses / Q000098:blood supply; D006801:Humans; D015994:Incidence; D007873:Legg-Calve-Perthes Disease / Q000453:epidemiology / Q000209:etiology*; D012863:Skeleton / Q000254:growth & development; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Allen's and Bergmann's rules; Legg-Calve-Perthes disease; animal models; biomechanical causes; etiology; rostral sparing; second-hand smoking; short stature; skeletal immaturity; socioeconomic status