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

Age - 4 to 9 yrs

Present - Painless Limp

Labs - normal

Xrays - Compression, collapse, frag-

mentation

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

- "Containment" by external orthoses, for up to 18 mo or surgery

- 50% of untreated get disabling arthritis

- younger diagnosed, better prog