legg- calve – perthes disease

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Legg- Calve – Perthes disease

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Legg- Calve – Perthes disease. Anatomy . Acetabular retroversion. Etiology of Legg-Calve- Perthes Disease. Factors That May Be Etiologic Trauma Susceptible child Hereditary factors Coagulopathy Hyperactivity Passives smoking Factors Unlikely To Be Etiologic Endocrinopathy - PowerPoint PPT Presentation

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Page 1: Legg- Calve –  Perthes  disease

Legg- Calve – Perthes disease

Page 2: Legg- Calve –  Perthes  disease
Page 3: Legg- Calve –  Perthes  disease

Anatomy

Page 4: Legg- Calve –  Perthes  disease

Acetabular retroversion

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Etiology of Legg-Calve-Perthes Disease

Factors That May Be Etiologic• Trauma• Susceptible child• Hereditary factors• Coagulopathy• Hyperactivity• Passives smoking

Factors Unlikely To Be Etiologic• Endocrinopathy• Urban environment• Synovitis

Page 6: Legg- Calve –  Perthes  disease

Clinical Features of Legg-Calve-Perthes Disease

• Onset: between 18months of age andskeletal maturity (most prevalent between 4-8years )12years of age• Male sex prevalence: the disease is four orfive times more likely to develop in boys thanin girls• Involvement: bilateral in 10%to 12% of patients

Page 7: Legg- Calve –  Perthes  disease

Clinical Features of Legg-Calve-Perthes Disease

Symptoms -limp that is exacerbated by activity and

alleviated with rest -pain, which may be located in the

groin,anterior hip region, medial knee joint or laterally around the greater Trochanter

- history of antecedent trauma

Page 8: Legg- Calve –  Perthes  disease

Clinical Features of Legg-Calve-Perthes Disease

Signs- Abductor limp

- Decreased range of motion of the hip, especially on abduction and internal rotation

- Flexion/extension less affected

Page 9: Legg- Calve –  Perthes  disease

Symptoms and Signs of Legg-Calve-Perthes Disease

Symptoms• Limping• Hip pain• Knee pain• History of trauma (?)Signs• Limp• Decreased hip range of motion• Spasm of long muscle around hip joint

Page 10: Legg- Calve –  Perthes  disease

Differential Diagnosis for Legg-Calve-Perthes Disease

Other Causes of Avascular Necrosis• Sickle cell disease• Other hemoglobinopathies• Thalassemia• Steroid medication• After traumatic hip fracture & dislocation• Treatment of developmental dysplasia of the hip

Page 11: Legg- Calve –  Perthes  disease

Pathologic Findings of Legg-Calve-Perthes Disease

Early Stage• Dead trabecular bone , Collapsed trabeculae• Thickened articular cartilage , Physeal disruption• Cartilage extending from the physis into the metaphysisFragmentation Stage• Invasion of vascular granulation tissue• New bone forming on old trabeculae• Woven new bone formationHealing Stage• New bone, woven and lamellar• Return to normai architecture

Page 12: Legg- Calve –  Perthes  disease

Differential Diagnosis for Legg-Calve-Perthes Disease

Epiphyseal Dysplasias• Muitiple epiphyseal dysplasia• Spondyloepiphyseal dysplasia• Mucopolysaccharidoses• Hypothyroidism

Page 13: Legg- Calve –  Perthes  disease

Differential Diagnosis for Legg-Calve-Perthes Disease

Other Syndromes• Osteochondromatosis• Metachondromatosis• Schwartz-Jam pel syndrome• Trichorhinophalangeal syndrome• Maroteaux-Lamy syndrome

Page 14: Legg- Calve –  Perthes  disease

Caterall classification

• Group I, partial head or less than half head involvement;

• Groups II and III, more than half head involvement and sequestrum formation

• Group IV, involvement of the entire epiphysis

Page 15: Legg- Calve –  Perthes  disease

Lateral pillar classification

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Imaging Evaluation

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Imaging Evaluation

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X-Ray

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Imaging Evaluation

• MRI• Bone scan• Arthrography• X-ray

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Treatment

The primary aim of treatment of Legg-Calv-Perthes disease is containment of the femoral head within the acetabulum

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Bracing

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Bracing

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Varus Derotational Osteotomy

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Proximal femoral varus osteotomy

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Proximal femoral valgus osteotomy

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Valgus osteotomy

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Triple pelvic osteotomy

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Triple ost.

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Shelf acetabuloplasty

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Chiari osteotomy

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Double-level osteotomy

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Greater trochanteric advancement

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Treatment

1. Most patients can be treated by noncontainment methods and obtain good results (84%). 2. Satisfactory clinical results frequently can be obtained at long-term follow-up despite an unsatisfactory radiographic appearance (nine hips). 3. The Catterall classification is a valid indicator of results, but is not applicable as a therapeutic guide for an average of 8.1 months after onset

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Treatment

4. Head-at-risk signs added little to the Catterall classification as a prognostic indicator or therapeutic guide. 5. All of the fair and poor results were in patients with Catterall III or IV involvement and onset of the disease at age 6 or older. (A Catterall III or IV classification is equivalent to Herring groups B and C.)

Page 39: Legg- Calve –  Perthes  disease

Scott – Schlatter disease

Page 40: Legg- Calve –  Perthes  disease

Scott – Schlatter disease