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Orthopedics 5th year, 3rd & 4th/part one lectures (Dr. Bakhtyar)
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Orthopedics 5th year, 3rd & 4th/part one lectures (Dr. Bakhtyar)

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The lecture has been given on Dec. 22nd, 2010 & Feb. 5th, 2011 by Dr. Bakhtyar.

The lecture has been given on Dec. 22nd, 2010 & Feb. 5th, 2011 by Dr. Bakhtyar.

Published in: Health & Medicine

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  • 1.
    • Perthes’ Disease (Coxa plana)
    • Legg-Calve- Perthes
  • 2.
    • Perthes’ Disease (Coxa plana)
    • Painful disorder of childhood characterized by necrosis of the femoral head.
    • Boys: Girls = 4:1
    • Age: 4-8 years
  • 3.
    • PATHOGENESIS
    • 3 sourses of blood supply to femoral head
    • 1- Metaphyseal vessels: Disappear at 4 years age
    • 2- Ligamentum teres vessels: develop fully at 7 years age
    • 3- Lateral epiphyseal vessels: All the ages
    • Between 4-7 y. the only sourse is lateral epiphyseal
  • 4. Trauma OR Non-specific synovitis ->effusion -> stretching of retinaculum -> obstruction of vessels -> necrosis
  • 5.
    • PATHOLOGY
    • 2-4 years
    • 3 stages :
    • 1- Bone Death
    • 2- Revascularization and repair
    • New bone is laid down on the dead trabeculae if:
    • (a) Part of the head is involved
    • (b)Repair process is rapid
    • Restoration of the bony architecture
    • 3- Distortion and remodeling if:
    • (a) A large piece is damaged
    • (b) Repair process is slow.
    • The head and neck are distorted
  • 6.
    • XRAY
    • (A)Early changes :(1) ↑density of the bony epiphysis
    • (2) ↑joint space (apparent)
    • (B)Later changes :(1) flattening(coxa plana)
    • (2) fragmentation
    • (3) coxa magna
    • (4) mushroom like head
    • (5) lateral displacement of the epiphysis
    • (6) sagging rope sign
    • (7) rarefaction and broadening of the metaphysis(neck)
  • 7.  
  • 8.  
  • 9.  
  • 10.
    • CLINICAL FEATURES
    • Boys: Girls = 4:1
    • 4-8 years
    • Pain in the groin ± knee
    • Limping
    • Little wasting of quadriceps ±
    • Early stage: The hip is irritable. i.e.:
    • All movements are diminished
    • Their extremes are painful
    • Later on (after the irritable state):
    • All movements are full except Abduction and Internal rotation
  • 11.
    • TREATMENT
    • (A)Irritable state: Skin traction till pain subsides (3 weeks)
    • (B) Further treatment depends on the assessment of prognosis
    • (a) Favourable prognostic signs
    • (1) Onset< 6 years
    • (2) Partial involvement of the femoral head
    • (3) Normal shape of the femoral head
    • (4) Absence of metaphyseal rarefaction
    • TREATMENT: Supervised Neglect
  • 12.
    • (b)Unfavourable prognostic signs
    • (1) >6 years age
    • (2) Whole femoral head involved
    • (3) Lateral displacement of the head
    • (4) Severe metaphyseal rarefaction
    • TREATMENT: Containment of the femoral head (Keeping the femoral head well seated within the acetabulum to retain its normal shape during the period of healing). This is achieved by 2 methods:
    • Conservative: Holding the hips widely abducted in POP or by a removable splint for 1 year.
    • .
  • 13. Surgery(a) Varus osteotomy of the femur (b) Innominate osteotomy of pelvis
  • 14.
    • NOTE: Those with very worse Xray changes, treatment is useless.