Osteonecrosis ug

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Osteonecrosis ug

  1. 1. Osteonecrosis Avascular Necrosis of Hip & Perthe’s Disease
  2. 2. Anatomy
  3. 3. Applied Anatomy
  4. 4. Causes
  5. 5. Pathogenesis
  6. 6. Pathology
  7. 7. Imaging
  8. 8. Sites..
  9. 9. Staging
  10. 10. Management
  11. 11. OSTEOCHONDROSIS (OSTEOCHONDRITIS)
  12. 12. AVN Hip
  13. 13. Retinacular Vessels
  14. 14. Clinical Features • Pain • Movement restriction – Abduction – Internal Rotation
  15. 15. X-Ray
  16. 16. Post Traumatic
  17. 17. MRI
  18. 18. Osteo Arthritis
  19. 19. STAGING
  20. 20. Core Decompression
  21. 21. Unloading Osteotomy
  22. 22. Arthroplasty
  23. 23. 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
  24. 24. Clinical Features • Pain • Movement restriction – Abduction – Internal Rotation • Limp
  25. 25. Herring’s Lateral Pillar Classification
  26. 26. Catterall’s Classification
  27. 27. Head at Risk Signs
  28. 28. 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.
  29. 29. Children under 6 years • No specific form of treatment has much influence on the outcome. • Symptomatic treatment, including activity modification, is appropriate.
  30. 30. Children aged 6–8 years • In this group the bone age is more important than the chronological age
  31. 31. 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.
  32. 32. 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.
  33. 33. Children 9 years and older • Except in very mild cases (which is rare), operative containment is the treatment of choice.
  34. 34. Aim of Treatment
  35. 35. Abduction Splint
  36. 36. Innominate osteotomy
  37. 37. Femoral Osteotomy
  38. 38. Innominate Osteotomy
  39. 39. Combined

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