| Muscular hypoplasia |
Radiation: >20 Gy (growing child); younger children more sensitive |
Asymmetry of muscle mass when compared with untreated area, decreased range of motion, stiffness and pain in affected area (uncommon) |
Careful comparison and measurement of irradiated and unirradiated areas, range of motion |
Prevention: good exercise program, range of motion, muscle strengthening |
|
Surgery: Muscle loss or resection |
| Spinal abnormalities: scoliosis, kyphosis, lordosis, decreased sitting height |
Radiation: For young children, radiation therapy to hemiabdomen or spine (especially hemivertebral); 10 Gy (minimal effect), >20 Gy (clinically notable defect) |
Back pain, hip pain, uneven shoulder height, rib humps or flares, deviation from vertical curve, gait abnormalities |
Standing and sitting height at each visit and plot on chart (stadiometer), during puberty examine spine every 3-6 months until growth is completed and then every 1–2 years, spinal films baseline during puberty, then as needed for curvature (COBB technique to measure curvature) |
Refer to orthopedist if any curvature is noted, especially during a period of rapid growth |
|
Surgery: Laminectomy |
| Length discrepancy |
Radiation: >20 Gy |
Lower back pain, limp, hip pain, discrepancy in muscle mass and length when compared with untreated extremity, scoliosis |
Annual measurement of treated and untreated limb (completely undressed patient to assure accurate measurements); radiograph baseline to assess remaining epiphyseal growth, radiographs annually during periods of rapid growth |
Contralateral epiphysiodesis; limb-shortening procedures |
| Pathological fracture |
Radiation: >40 Gy |
Pain, edema, ecchymosis |
Baseline radiograph of treated area to assess bone integrity, then as needed for symptoms |
Prevention: consider limitation of activities (e.g., contact sports) surgical repair of fracture; may require internal fixation |
|
Surgery: Biopsy |
| Osteonecrosis |
Chemotherapy: Steroids |
Pain in affected joint, limp |
Radiograph, CT scan as needed for symptoms |
Symptomatic care; joint replacement |
|
Radiation: >40–50 Gy (more common in adults) |
| Osteocartilaginous exostoses |
Radiation
|
Painless lump/mass noted in the field of radiation |
Radiograph baseline and as needed for growth of lesion |
Resection for cosmetic/functional reasons, counsel regarding 10% incidence of malignant degeneration |
| Osteopenia/osteoporosis |
Chemotherapy: Steroids |
Fractures, pain |
DEXA — intervals of testing unclear. Pediatric norms not well established. Best data are in adults |
Calcium supplementation, increase weight-bearing exercise; refer to endocrinology for possible bisphosphonate therapy |
|
Radiation: >18 Gy cranial radiation therapy |
| Slipped capitofemoral epiphysis |
Chemotherapy: High-dose steroids |
Pain in affected hip, limp, abnormal gait |
Radiograph baseline to assess integrity of the treated joint(s), then as needed for symptoms |
Refer to orthopedist for surgical intervention |
|
Radiation: >25 Gy (at young age) |
