legg calve perthes disease

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Legg calve perthes disease By: Ala’a AlGhanem | 211508057 | B1

Author: alaa-al-ghanem

Post on 16-Aug-2015

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  1. 1. Legg calve perthes disease By: Alaa AlGhanem | 211508057 | B1
  2. 2. Learning Objectives: Normal anatomy of hip joint. Introduction and epidemiology Aetiology and classifications Clinical presentation Investigations Treatment and prognosis Complications
  3. 3. Anatomy of hip joint:
  4. 4. Legg calve perthes disease Idiopathic avascular necrosis of the proximal femoral epiphysis in children Legg Calve Perthes
  5. 5. Epidemiology: 2-Sex: 1-incidence: affects 1 in 1200 children > 5 : 1
  6. 6. 3-Age 4-8 years is most common age of presentation 4-Population: more commonly seen in urban populations versus rural 5-Location: bilateral in 12% ( never at the same stage of disease)
  7. 7. the exact cause of disruption of blood supply remains unknown. Etiology: Associated conditions: -ADHD (33%) -delayed bone age (98%) -Thrombophilia (50%)
  8. 8. how Avascular necrosis (AVN) develops:
  9. 9. Risk Factors: 1-positive family history 2-low birth weight 3-abnormal birth presentation 4-children exposed to second hand smoke 5-Asian, Inuit, and Central European decent
  10. 10. Classifications: Waldenstrm Lateral Pillar (Herring ) Classification Catterall Classification Salter-Thompson classification Stulberg classification
  11. 11. Stages of Legg-Calves-Perthes (Waldenstrm) Initial stage (infarction) Fragmentation Reossification Healing or remodeling
  12. 12. Lateral Pillar (Herring ) Classification Determined at the beginning of fragmentation stage lateral pillar maintains full height Maintains >50% height Maintains 1/2 of femoral head Class A Class B
  13. 15. Stulberg classification normal Spherical head with enlargement, short neck, or steep acetabulum Nonspherical head Flat head Flat head with incongruent hip joint Gold standard for rating residual femoral head deformity and joint congruence
  14. 16. Clinical presentation: -insidious onset -may cause painless limp -intermittent knee, hip, groin or thigh pain Physical Exam: Symptoms: -Trendelenburg gait -antalgic limp limb length discrepancy is a late finding -hip stiffness with loss of internal rotation and abduction -gait disturbance:
  15. 17. Investigations: Plain radiographs: AP of pelvis and frog leg laterals early findings include: medial joint space widening (earliest) irregularity of femoral head ossification cresent sign (represents a subchondral fracture)
  16. 18. MRI can provide early diagnosis revealing alterations in the capital femoral epiphysis and physis. Bone scan: can confirm suspected case of LCP decreased uptake (cold lesion) can predate changes on radiographs Arthrogram a dynamic arthrogram can demonstrate coverage and containment of the femoral head
  17. 19. Differential Diagnosis multiple epiphyseal dysplasia spondyloepiphyseal dysplasia sickle cell disease Gaucher disease hypothyroidism Meyers dysplasia
  18. 20. Treatment: The main Goals of treatment: 1-keep the femoral head contained and maintain good motion 2-containment limits deformity and minimizes loss of sphericity and lessen subsequent degenerative changes.
  19. 21. Non-operative: observation alone, activity restriction, and physical therapy Indications: 1-children < 8 years of age 2-children with lateral pillar A 3-consider activity restriction and protected weight-bearing during earlier stages until reossification is complete
  20. 22. techniques: Cast Brace
  21. 23. Operative: Femoral or pelvic osteotomy Indications: 1-children > 8 years of age, especially lateral pillar B and B/C improved outcomes with surgery for lateral pillar B and B/C in children > 8 years poor outcome for lateral pillar C regardless of treatment.
  22. 24. Pelvic osteotomy: Dega Osteotomy Salter (Innominate) Osteotomy
  23. 25. Femoral osteotomy: Varus femoral osteotomy
  24. 26. Prognosis: prognosis worse with: 1-age (bone age) > 6 years at presentation 2-female sex 3-decreased hip range of motion (abduction) prognosis improved with: 1-age (bone age) < 6 years at presentation
  25. 27. Complications: The head of the femur may lose its normal, spherical shape and/or collapse. Also, degenerative joint disease can occur (i.e. as occurs in osteoarthritis). The affected leg may lose some of its motion and may become shorter than the normal leg.
  26. 28. References: Johns Hopkins Pediatric Orthopaedics Patient
  27. 29. Thank You