{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T19:21:58Z","timestamp":1791400918652,"version":"4.3.3"},"reference-count":15,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2016,7,7]],"date-time":"2016-07-07T00:00:00Z","timestamp":1467849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hand (New York, N,Y.)"],"published-print":{"date-parts":[[2016,9]]},"abstract":"<jats:p>Background: The etiology of multifocal osteonecrosis is not definitively known; however, hypercoagulable state is a very plausible cause. Methods: We present an unusual case of a 12-year-old boy with a history of Legg-Calve-Perthes disease presenting with right wrist pain who was subsequently diagnosed with Kienbock\u2019s disease. The finding of multifocal osteonecrosis prompted testing for a hypercoagulable state that was positive for Factor V Leiden thrombophilia. A thorough literature review using Medline database was conducted to investigate associations between inherited hypercoagulable states and multifocal osteonecrosis. Results: Our literature review identified 2 similar cases of multifocal osteonecrosis associated with a hypercoagulable disorder in adult patients. There were no reports among the pediatric patient population. Meta-analysis has demonstrated a potential link between Legg-Calve-Perthes disease and Factor V Leiden thrombophilia. Conclusions: This study offers further evidence to support the theory that multifocal osteonecrosis may be linked to a hypercoagulable state. Patients presenting with multifocal osteonecrosis should undergo screening for hypercoagulable states. Further investigation is needed to ascertain the potential benefit of prophylactic anticoagulation in patients with a known hypercoagulable state and multifocal osteonecrosis.<\/jats:p>","DOI":"10.1177\/1558944715627274","type":"journal-article","created":{"date-parts":[[2016,5,6]],"date-time":"2016-05-06T15:22:26Z","timestamp":1462548146000},"page":"NP16-NP19","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Bilateral Legg-Calve-Perthes Disease and Kienbock\u2019s Disease in a Child With Factor V Leiden Thrombophilia"],"prefix":"10.1177","volume":"11","author":[{"given":"Heather L.","family":"Baltzer","sequence":"first","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Riester","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven L.","family":"Moran","sequence":"additional","affiliation":[{"name":"Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2016,7,7]]},"reference":[{"key":"bibr1-1558944715627274","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2008.09.019"},{"key":"bibr2-1558944715627274","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200412000-00009"},{"key":"bibr3-1558944715627274","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-008-0147-1"},{"issue":"4","key":"bibr4-1558944715627274","first-page":"361","volume":"69","author":"De Smet L","year":"2003","journal-title":"Acta Orthop Belg"},{"key":"bibr5-1558944715627274","doi-asserted-by":"publisher","DOI":"10.1097\/01241398-199901000-00018"},{"key":"bibr6-1558944715627274","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.G.00616"},{"key":"bibr7-1558944715627274","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000007"},{"key":"bibr8-1558944715627274","doi-asserted-by":"publisher","DOI":"10.1177\/1753193410364913"},{"key":"bibr9-1558944715627274","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2004.10.002"},{"key":"bibr10-1558944715627274","doi-asserted-by":"publisher","DOI":"10.1016\/j.ocl.2006.10.010"},{"key":"bibr11-1558944715627274","doi-asserted-by":"publisher","DOI":"10.5858\/2007-131-866-APCRAF"},{"key":"bibr12-1558944715627274","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2008.10.015"},{"issue":"3","key":"bibr13-1558944715627274","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/S0749-0712(21)01260-9","volume":"9","author":"Williams CS","year":"1993","journal-title":"Hand Clin"},{"key":"bibr14-1558944715627274","doi-asserted-by":"publisher","DOI":"10.1007\/s11552-012-9465-6"},{"key":"bibr15-1558944715627274","doi-asserted-by":"publisher","DOI":"10.1002\/jor.22473"}],"container-title":["HAND"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1558944715627274","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1558944715627274","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1558944715627274","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:28:15Z","timestamp":1777447695000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1558944715627274"}},"subtitle":["A Case Report"],"short-title":[],"issued":{"date-parts":[[2016,7,7]]},"references-count":15,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2016,9]]}},"alternative-id":["10.1177\/1558944715627274"],"URL":"https:\/\/doi.org\/10.1177\/1558944715627274","relation":{},"ISSN":["1558-9447","1558-9455"],"issn-type":[{"value":"1558-9447","type":"print"},{"value":"1558-9455","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,7,7]]}}}