REVIEW  PEDIATRIC ORTHOPEDICS 

Minerva Ortopedica e Traumatologica 2019 March;70(1):32-9

DOI: 10.23736/S0394-3410.19.03908-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Avascular necrosis of the talus in pediatric acute lymphoblastic leukemia: current concepts

Andrea COSSIO ¹, Marco BIGONI ^{1, 2}, Antonino S. LOMBARDO ¹ ✉, Jole GRACI ^{1, 3}, Davide BORRA ¹, Adriana BALDUZZI ⁴, Erica BRIVIO ⁴, Marco TURATI ^{1, 5}, Giovanni ZATTI ^{1, 2}

¹ Orthopedics Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; ² School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; ³ Department of Pediatric Orthopedics, Saint Joseph Hospital, Marseille, France; ⁴ Department of Pediatrics, MBBM Foundation, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; ⁵ Department of Pediatric Orthopedic Surgery, University Hospital Grenoble-Alpes, University Grenoble-Alpes, Grenoble, France

Avascular necrosis (AVN) is a disease due to the interruption of the blood supply to the bone. It is one of the most common and debilitating therapy-related sequelae of the antileukemic treatment and it may not be clinically recognized. Symptomatic AVN have been reported in 1-17% of children with acute lymphoblastic leukemia (ALL) during treatment or thereafter although an incidence of up to 72% of asymptomatic AVN has been detected with systematic screening by magnetic resonance imaging (MRI). In all cases AVN is related to ALL treatment and in particular to high-dose steroids. While the AVN of the hip is frequently reported in the literature, reports regarding AVN of the talus are lacking; moreover, there is little consensus about its incidence, diagnostic algorithm and treatment. Talus is an articular weight-bearing bone with over 60% of the surface covered by cartilage and a specific limited vascular supply. The aim of this article is to provide an up-to-date review about management of avascular necrosis of the talus highlighting the importance of early diagnosis based on ankle MRI imaging in pediatric patients affected with ALL.

KEY WORDS: Precursor cell lymphoblastic leukemia-lymphoma - Osteonecrosis - Talus - Child