Orthopedics Book

http://www.fpnotebook.com/

Legg-Calve-Perthes

Aka: Legg-Calve-Perthes, Aseptic Necrosis of the Femoral Head, Perthes Disease
  1. See Also
    1. Pediatric Limp
    2. Osteochondrosis
  2. Epidemiology
    1. Children age 4-8 years old
    2. Boys affected 4-5 times more often than girls
    3. Familial in 20% of cases
    4. Incidence 1:1000 to 1:5000
  3. Risk Factors
    1. Boys
    2. Low birth weight
    3. Abnormal birth presentation (e.g. Breech Presentation)
    4. Family History
    5. Higher birth order
    6. Lower socioeconomic status
  4. Pathophysiology
    1. Juvenile idiopathic avascular necrosis of femoral head
      1. Results from a partial interruption of the blood supply to the femoral head
  5. Etiology
    1. Idiopathic Osteochondrosis
  6. Symptoms
    1. Pain in area of hip and may be referred to knee
  7. Signs
    1. Child walks with a limp
    2. Decreased hip range of motion
      1. Limited hip abduction
      2. Limited internal rotation
    3. Leg Length Discrepancy
  8. Imaging
    1. Views
      1. Anteroposterior Pelvis
      2. Frog-leg lateral hip
    2. Findings
      1. Proximal femur growth center with fragmentation, flattening, and sclerosis
      2. Joint space widening
  9. Differential Diagnosis
    1. Septic Joint
    2. Proximal femur Osteomyelitis
  10. Management
    1. Orthopedic consultation in all cases
    2. Difficult management
      1. Long-term treatment
      2. Limited activity
    3. Bracing and Casting for up to 1-2 years
    4. Surgical reconstruction to improve Hip Joint congruity
      1. Allows child back to activity in 4-6 months
  11. Complications
    1. Severe degenerative hip disease
      1. Requires hip replacement by middle age in 50% cases
  12. Prognosis
    1. Fair at best to avoid longterm arthritis (see complications above)
    2. Best prognosis for optimal range of motion is with early treatment at young age
    3. Predictors of worse prognosis
      1. Age over 6 years at onset of condition
      2. More severely affected femoral head deformity
      3. Hip Joint incongruity
      4. Decreased hip range of motion
  13. References
    1. Atanda (2011) Am Fam Physician 83(3): 285-91
    2. Wiig (2008) J Bone Joint Surg Br 90(10): 1364-71

Navigation Tree