Legg-Calve-Perthes disease

Background

• ischemic necrosis of femoral head
• exact mech unknown
• more common in boys
• 10% of cases occur bilaterally
• inc 1 per 1200 - 12,000

Diagnosis

• Age - 4 to 9 yrs
• Present - Painless Limp
• Labs - normal
• Xrays - Compression, collapse, fragmentation

Presentation

• classically a painless limp
• may have mild, intermittent pain in hip, groi, thigh or knee
• pain often activiity related & relieveed by rest.

Physical Exam

• decr range of motion, esp internal rotation and abduction.
• may have leg length discrepancy Xrays
• initially show increase in articular space or compression of bone
• as necrosis progresses, epiphysis will collapse and fragment

Treatment

1. "Containment" by external orthoses, for up to 18 mo or surgery
2. 50% of untreated get disabling arthritis
3. younger diagnosed, better prog

See Also

Hip Pain (Peds)