Legg-Calve-Perthes disease: Difference between revisions

Latest revision as of 22:09, 23 August 2019

Background

Avascular necrosis of femoral head
- Capital femoral epiphysis fails to grow because of lack of blood supply
Affects children 4-9yr old
Male:female 4:1
Bilateral in 10%

Clinical Features

Insidious onset of mild hip pain and limp
- May have painless limp
- May have referred pain to groin, thigh, knee
Pain often exacerbated by activity, relieved with rest
Decreased hip abduction and internal rotation

Differential Diagnosis

Pediatric limp

Hip Related

Other Causes of Limping

Developmental dysplasia
Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
Osteomyelitis
Myositis
Other:

Evaluation

Plain radiographs of the hip
- May be normal early in disease
- If high suspicion obtain bone scan or MRI
Imaging findings:
- Widening of cartilage space of affected hip
- Small size ossific nucleus of femoral head
- Subchondral stress fracture line in femoral head

Management

Orthopedic surgery consultation
Non-weight bearing
Protection of hip joint (maintain in abduction and internal rotation)

Disposition

Generally may be discharged
- Should be done in consultation with orthopedic surgery to ensure appropriate therapy and close follow-up

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-* ischemic necrosis of femoral head
+*[[Avascular necrosis of hip|Avascular necrosis of femoral head]]
-* exact mech unknown
+**Capital femoral epiphysis fails to grow because of lack of blood supply
-* more common in boys
+*Affects children 4-9yr old
-* 10% of cases occur bilaterally
+*Male:female 4:1
-* inc 1 per 1200 - 12,000
+*Bilateral in 10%
-==Diagnosis==
+==Clinical Features==
-*Age - 4 to 9 yrs
+*Insidious onset of mild [[hip pain]] and [[limp]]
-*Present - Painless Limp
+**May have painless limp
-*Labs - normal
+**May have referred pain to groin, thigh, knee
-*Xrays - Compression, collapse, fragmentation
+*Pain often exacerbated by activity, relieved with rest
+*Decreased hip abduction and internal rotation
-===Presentation===
+==Differential Diagnosis==
-* classically a painless limp
+{{Pediatric hip DDX}}
-* may have mild, intermittent pain in hip, groi, thigh or knee
-* pain often activiity related & relieveed by rest.
-===Physical Exam===
+==Evaluation==
-* decr range of motion, esp internal rotation and abduction.
+[[File:Roe-perthes.jpg|thumb|]]
-* may have leg length discrepancy Xrays
+*Plain radiographs of the hip
-* initially show increase in articular space or compression of bone
+**May be normal early in disease
-* as necrosis progresses, epiphysis will collapse and fragment
+**If high suspicion obtain bone scan or MRI
+*Imaging findings:
+**Widening of cartilage space of affected hip
+**Small size ossific nucleus of femoral head
+**Subchondral stress fracture line in femoral head
-==Treatment==
+==Management==
-# "Containment" by external orthoses, for up to 18 mo or surgery
+*Orthopedic surgery consultation
-# 50% of untreated get disabling arthritis
+*Non-weight bearing
-# younger diagnosed, better prog
+*Protection of hip joint (maintain in abduction and internal rotation)
+==Disposition==
+*Generally may be discharged
+**Should be done in consultation with orthopedic surgery to ensure appropriate therapy and close follow-up
 ==See Also==
-[[Hip Pain (Peds)]]
+*[[Pediatric hip pain]]
+==References==
+<references/>
-[[Category:Peds]]
+[[Category:Pediatrics]]
-[[Category:Ortho]]
+[[Category:Orthopedics]]