legg calve perthes

  • related: Pediatric
  • pt:
    • 4-8 years, male predominant
    • higher risk with FHx, low birth weight, 2nd hand smoking
  • cause: idiopathic avascular necrosis of the femoral head. Interruption of the blood supply by a currently unknown cause.
  • symptoms:
    • slow onset
    • gradual painless limp
    • intermittent knee, hip, groin, thigh pain
  • dx
    • Hip stiffness with loss of internal rotation and abduction
    • Gait disturbance
    • Limb length discrepancy (late disease finding)
  • x ray finding:
    • Medial joint space widening (earliest finding)
    • Small femoral head due to irregularity of the femoral head ossification center
    • Subchondral fracture
  • rx:
    • treatment strategy is containment of the hip within the acetabulum by either bracing or surgical means.
    • Operative treatment is indicated in children over age 8 or in cases of permanent hip dysplasia, and involves acetabular reconstruction
  • complications
    • Osteoarthritis
    • Progressive avascular necrosis
    • Early arthroplasty in cases of permanent dysplasia.,