Osteonecrosis ug
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Osteonecrosis ug

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Osteonecrosis ug Osteonecrosis ug Presentation Transcript

  • Osteonecrosis Avascular Necrosis of Hip & Perthe’s Disease
  • Anatomy
  • Applied Anatomy
  • Causes
  • Pathogenesis
  • Pathology
  • Imaging
  • Sites..
  • Staging
  • Management
  • OSTEOCHONDROSIS (OSTEOCHONDRITIS)
  • AVN Hip
  • Retinacular Vessels
  • Clinical Features • Pain • Movement restriction – Abduction – Internal Rotation
  • X-Ray
  • Post Traumatic
  • MRI
  • Osteo Arthritis
  • STAGING
  • Core Decompression
  • Unloading Osteotomy
  • Arthroplasty
  • PERTHES’ DISEASE • Perthes’ disease – or rather Legg– Calvé–Perthes disease. • 1910-the condition was described independently by three different people • is a painful disorder of childhood characterized by avascular necrosis of the femoral head
  • Clinical Features • Pain • Movement restriction – Abduction – Internal Rotation • Limp
  • Herring’s Lateral Pillar Classification
  • Catterall’s Classification
  • Head at Risk Signs
  • GUIDELINES TO TREATMENT • based on an assessment of – the stage of the disease, – the prognostic x-ray classifications, – the age of the patient – The clinical features, particularly range of abduction and extension.
  • Children under 6 years • No specific form of treatment has much influence on the outcome. • Symptomatic treatment, including activity modification, is appropriate.
  • Children aged 6–8 years • In this group the bone age is more important than the chronological age
  • Bone age at or below 6 years • Lateral pillar group A and B (or Catterall stage I and II) – symptomatic treatment. • Lateral pillar group C (or Catterall stage III and IV) – abduction brace.
  • Bone age over 6 years • Lateral pillar group A and B (Catterall stage I and II) – abduction brace or osteotomy. • Lateral pillar group C (Catterall stage III and IV) –outcome probably unaffected by treatment, but some would operate.
  • Children 9 years and older • Except in very mild cases (which is rare), operative containment is the treatment of choice.
  • Aim of Treatment
  • Abduction Splint
  • Innominate osteotomy
  • Femoral Osteotomy
  • Innominate Osteotomy
  • Combined