Leg-Calve-Perthes Disease


 Van Der Geest IC, Kooijman MA, Spruit M, Anderson PG, De Smet PM. Shelf acetabuloplasty for Perthes' disease: 12-year follow-up. Acta Orthop Belg. 2001 Apr;67(2):126-31. PMID: 11383290.


What does the x-ray illustrate ? 

 The first x-ray photograph shows AP Hip joint of a skeletally immature with a flattened and deformed femoral head suggestive of Perthes disease.

 The second photograph is a good follow up of the same case after 12 years. We can see the remodeling of femoral head following Shelf procedure.


What is underlying problem in this disease and who suffers from this ?

 Idiopathic AVN of proximal femoral epiphysis in childhood. Unknown etiology.

  Boys and girls invovement ratio 4:1. Bilateral in 20 % cases.

    

Classification - Waldenstrom 

    stages of pathology

    1.Initial avascular event (crescent sign-representing subchondral fracture)

    2.Fragmentation 

    3.Resolution

    4. Remodelling

 Herring's Classification- based on lateral Pillar height on AP radiograph during Fragmentation

    A - Height of lateral Pillar is normal

    B - > 50 % maintained

    C- < 50 % maintained

 Caterall's classification - depending on head involved on lateral radiograph.

    also added head at risk signs. 

    Clinically - obese child, progressive loss of ROM ( Abduction contracture, ER with flexion)

    Radiologically - Horizontal physis, lateral  subluxation of epiphysis, lateral calcification, 

                                Diffuse metaphyseal reaction, Gaze sign - inverted U-shaped lucency in lateral                                         metaphysis

Stullberg's classification - based on shape of femoral head 

    I - normal

    II- head is spherical (magna/breva ) fits into socket

    III- mushroom head,congruent

    IV- flat head and flat socket

    V- flat head and congruent

Principles of Management 

    Symptomatic Relief 

    Containment

    Restore ROM

    Goals are achieved by non-operative and operative measures.Management depends upon age,clinical       signs and radiological appearances on x-ray. 

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