legg- calve – perthes disease
DESCRIPTION
Legg- Calve – Perthes disease. Anatomy . Acetabular retroversion. Etiology of Legg-Calve- Perthes Disease. Factors That May Be Etiologic Trauma Susceptible child Hereditary factors Coagulopathy Hyperactivity Passives smoking Factors Unlikely To Be Etiologic Endocrinopathy - PowerPoint PPT PresentationTRANSCRIPT
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Legg- Calve – Perthes disease
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Anatomy
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Acetabular retroversion
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Etiology of Legg-Calve-Perthes Disease
Factors That May Be Etiologic• Trauma• Susceptible child• Hereditary factors• Coagulopathy• Hyperactivity• Passives smoking
Factors Unlikely To Be Etiologic• Endocrinopathy• Urban environment• Synovitis
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Clinical Features of Legg-Calve-Perthes Disease
• Onset: between 18months of age andskeletal maturity (most prevalent between 4-8years )12years of age• Male sex prevalence: the disease is four orfive times more likely to develop in boys thanin girls• Involvement: bilateral in 10%to 12% of patients
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Clinical Features of Legg-Calve-Perthes Disease
Symptoms -limp that is exacerbated by activity and
alleviated with rest -pain, which may be located in the
groin,anterior hip region, medial knee joint or laterally around the greater Trochanter
- history of antecedent trauma
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Clinical Features of Legg-Calve-Perthes Disease
Signs- Abductor limp
- Decreased range of motion of the hip, especially on abduction and internal rotation
- Flexion/extension less affected
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Symptoms and Signs of Legg-Calve-Perthes Disease
Symptoms• Limping• Hip pain• Knee pain• History of trauma (?)Signs• Limp• Decreased hip range of motion• Spasm of long muscle around hip joint
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Differential Diagnosis for Legg-Calve-Perthes Disease
Other Causes of Avascular Necrosis• Sickle cell disease• Other hemoglobinopathies• Thalassemia• Steroid medication• After traumatic hip fracture & dislocation• Treatment of developmental dysplasia of the hip
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Pathologic Findings of Legg-Calve-Perthes Disease
Early Stage• Dead trabecular bone , Collapsed trabeculae• Thickened articular cartilage , Physeal disruption• Cartilage extending from the physis into the metaphysisFragmentation Stage• Invasion of vascular granulation tissue• New bone forming on old trabeculae• Woven new bone formationHealing Stage• New bone, woven and lamellar• Return to normai architecture
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Differential Diagnosis for Legg-Calve-Perthes Disease
Epiphyseal Dysplasias• Muitiple epiphyseal dysplasia• Spondyloepiphyseal dysplasia• Mucopolysaccharidoses• Hypothyroidism
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Differential Diagnosis for Legg-Calve-Perthes Disease
Other Syndromes• Osteochondromatosis• Metachondromatosis• Schwartz-Jam pel syndrome• Trichorhinophalangeal syndrome• Maroteaux-Lamy syndrome
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Caterall classification
• Group I, partial head or less than half head involvement;
• Groups II and III, more than half head involvement and sequestrum formation
• Group IV, involvement of the entire epiphysis
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Lateral pillar classification
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Imaging Evaluation
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Imaging Evaluation
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X-Ray
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Imaging Evaluation
• MRI• Bone scan• Arthrography• X-ray
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Treatment
The primary aim of treatment of Legg-Calv-Perthes disease is containment of the femoral head within the acetabulum
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Bracing
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Bracing
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Varus Derotational Osteotomy
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Proximal femoral varus osteotomy
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Proximal femoral valgus osteotomy
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Valgus osteotomy
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Triple pelvic osteotomy
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Triple ost.
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Shelf acetabuloplasty
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Chiari osteotomy
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Double-level osteotomy
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Greater trochanteric advancement
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Treatment
1. Most patients can be treated by noncontainment methods and obtain good results (84%). 2. Satisfactory clinical results frequently can be obtained at long-term follow-up despite an unsatisfactory radiographic appearance (nine hips). 3. The Catterall classification is a valid indicator of results, but is not applicable as a therapeutic guide for an average of 8.1 months after onset
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Treatment
4. Head-at-risk signs added little to the Catterall classification as a prognostic indicator or therapeutic guide. 5. All of the fair and poor results were in patients with Catterall III or IV involvement and onset of the disease at age 6 or older. (A Catterall III or IV classification is equivalent to Herring groups B and C.)
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Scott – Schlatter disease
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Scott – Schlatter disease