legg calve Perthes disease
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Legg Calve Perthes disease is avascular necrosis of the femoral head in children, most commonly affecting boys ages 4-8. It has an unknown cause but may be associated with conditions like ADHD. Presentation includes a limp or hip/thigh pain. X-rays show changes in the femoral head over time. Treatment depends on age and classification, ranging from observation to osteotomies, with the goal of containing the femoral head to prevent deformity and future arthritis. Prognosis is worse with older age at onset and decreased hip range of motion. Complications can include femoral head deformity, collapse, and leg length discrepancy.
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Perthes disease
Perthes disease is a childhood condition that affects the blood supply to the femoral head, causing bone death (avascular necrosis). It most commonly affects boys between ages 4-8. While the disease process is self-limiting, it can have permanent effects on the femoral head shape and hip function. Treatment aims to contain the femoral head within the acetabulum during healing to promote proper reshaping, through nonsurgical means like bracing or surgical options like osteotomies if needed. The long-term outcomes are evaluated using classifications like Stulberg or Mose, with the goal of achieving a spherical femoral head congruent with the acetabulum. Management approaches vary between centers based on each child's severity and prognosis
Classification & management of legg calve perthes disease
This document discusses Legg-Perthes disease (LPD), a childhood condition causing temporary osteonecrosis of the femoral head. It provides details on:
1. Diagnostic imaging techniques used including X-rays, MRI, bone scans, and arthrography. X-rays can classify LPD into stages and assess head shape.
2. Classification systems for LPD staging and outcome prediction including Waldenstrom, Catterall, Herring, and Stulberg systems. These consider factors like head shape, containment, and congruency.
3. Non-surgical and surgical treatment options from observation to hip bracing to osteotomies. The goal is containment of the femoral
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Perthes disease
Perthes disease is a childhood condition that affects the blood supply to the femoral head, causing bone death (avascular necrosis). It most commonly affects boys between ages 4-8. While the disease process is self-limiting, it can have permanent effects on the femoral head shape and hip function. Treatment aims to contain the femoral head within the acetabulum during healing to promote proper reshaping, through nonsurgical means like bracing or surgical options like osteotomies if needed. The long-term outcomes are evaluated using classifications like Stulberg or Mose, with the goal of achieving a spherical femoral head congruent with the acetabulum. Management approaches vary between centers based on each child's severity and prognosis
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perthes disease
Legg - Calve - Perthes disease is a self-limiting disorder of the hip caused by reduced blood flow and necrosis of the femoral head. It most commonly affects boys ages 4-8 and is characterized by pain and limping. While the exact cause is unknown, factors such as blood clotting disorders, abnormal arterial or venous blood flow, growth delays, trauma, genetics, and environmental influences may play a role in reducing blood supply to the femoral head. Treatment aims to allow the femoral head to remodel itself through non-weight bearing or minimal weight bearing methods.
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This document summarizes the pathogenesis and treatment of Legg-Calve-Perthes disease, a childhood hip condition caused by interrupted blood supply to the femoral head. The disease leads to bone death and deformity of the femoral head. Treatment options are controversial but generally involve either nonoperative casting or operative procedures like osteotomies, depending on the age, stage of disease, and extent of involvement. Current evidence suggests operative treatments may slightly increase the chance of a spherical femoral head developing, but the effect is modest and more research is still needed to develop more effective therapies.
Legg calve perthes disease
Perthes disease, also known as Legg-Calve-Perthes disease, is caused by impaired blood flow in the femoral head that leads to bone death in children aged 3-12 years old, causing deformity of the femoral head; it is more common in boys and whites and symptoms include limping and hip pain that varies depending on the stage of bone regeneration. Genetic factors and growth abnormalities play a role in its development.
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Legg calve perthes
Legg Calve Perthes disease, also known as osteochondritis of the femoral capital epiphysis, is characterized by idiopathic avascular osteonecrosis of the femoral head in young children, typically ages 4-8 years. It progresses through four stages - initial, fragmentation, reossification, and healed. Common symptoms include limping, hip or thigh pain, and limited range of motion. Imaging such as x-rays, ultrasound, CT, MRI, and bone scans can detect signs like femoral head flattening, sclerosis, fragmentation, and joint effusion that correspond to the disease stages. While the cause is unknown, it is more common in boys and low socioeconomic groups.
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perthes disease
This document provides an overview of Legg Calve Perthes disease, including its definition, demographics, risk factors, pathogenesis, clinical features, investigations, classifications, management, and surgical procedures. Some key points:
- It is avascular necrosis of the femoral head in children, most common in ages 4-8 years. Positive family history and low birth weight are risk factors.
- Clinical features include hip/thigh pain aggravated by movement. Imaging shows stages from avascular necrosis to fragmentation to regeneration/healing.
- Conservative management includes bracing for young/mild cases. Surgical containment is used for more severe/older cases to encourage spherical remodeling.
- Procedures
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2) The physical examination evaluates posture, spinal alignment, and flexibility from multiple angles. It also evaluates the shoulders, ribs, pelvis, and for any neurological deficits.
3) Imaging studies like x-rays can further characterize the curve severity, skeletal maturity, and help determine a treatment plan. Together the history, exam, and imaging allow for an accurate diagnosis and clinical decision making.
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Perthes disease is avascular necrosis of the femoral head in children caused by interrupted blood supply. It typically affects children ages 4-8 years old. Presentation includes limping and hip pain. Treatment depends on the stage and aims to contain the femoral head through casting, bracing, or surgery. Containment redirects forces on the femoral head to allow remodeling. Late treatment focuses on improving range of motion and reshaping deformities through osteotomies or salvage surgery. The long term goal is to produce a normal hip joint and prevent arthritis.
Nitin perthes
This document provides information on Legg Calve Perthes disease, including:
- A brief history of its discovery and description by Legg, Calve, and Perthes.
- Its definition as osteonecrosis of the femoral epiphysis in children caused by non-genetic factors.
- Presentation, diagnosis using imaging like x-rays and MRI, and classifications of severity.
- Management involves containment of the femoral head through bracing, casting, or surgery depending on the stage and prognosis. The goal is to prevent secondary arthritis by achieving a spherical femoral head.
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perthes disease
Legg - Calve - Perthes disease is a self-limiting disorder of the hip caused by reduced blood flow and necrosis of the femoral head. It most commonly affects boys ages 4-8 and is characterized by pain and limping. While the exact cause is unknown, factors such as blood clotting disorders, abnormal arterial or venous blood flow, growth delays, trauma, genetics, and environmental influences may play a role in reducing blood supply to the femoral head. Treatment aims to allow the femoral head to remodel itself through non-weight bearing or minimal weight bearing methods.
Legg calve perthes
This document summarizes the pathogenesis and treatment of Legg-Calve-Perthes disease, a childhood hip condition caused by interrupted blood supply to the femoral head. The disease leads to bone death and deformity of the femoral head. Treatment options are controversial but generally involve either nonoperative casting or operative procedures like osteotomies, depending on the age, stage of disease, and extent of involvement. Current evidence suggests operative treatments may slightly increase the chance of a spherical femoral head developing, but the effect is modest and more research is still needed to develop more effective therapies.
Legg calve perthes disease
Perthes disease, also known as Legg-Calve-Perthes disease, is caused by impaired blood flow in the femoral head that leads to bone death in children aged 3-12 years old, causing deformity of the femoral head; it is more common in boys and whites and symptoms include limping and hip pain that varies depending on the stage of bone regeneration. Genetic factors and growth abnormalities play a role in its development.
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Developmental dysplasia of the hip (DDH) is a spectrum of disorders involving abnormal development of the hip joint that may present as dysplasia, subluxation, or dislocation. It results from excessive laxity of the hip capsule allowing the femoral head to slip out of the acetabulum. DDH is diagnosed through clinical examination including Ortolani and Barlow's tests in infants, and imaging such as ultrasound and x-rays. Treatment depends on the degree of hip involvement and age of presentation, ranging from bracing to closed or open reduction. Screening of newborns is important for early detection and management to prevent long-term complications.
Legg calve perthes
Legg Calve Perthes disease, also known as osteochondritis of the femoral capital epiphysis, is characterized by idiopathic avascular osteonecrosis of the femoral head in young children, typically ages 4-8 years. It progresses through four stages - initial, fragmentation, reossification, and healed. Common symptoms include limping, hip or thigh pain, and limited range of motion. Imaging such as x-rays, ultrasound, CT, MRI, and bone scans can detect signs like femoral head flattening, sclerosis, fragmentation, and joint effusion that correspond to the disease stages. While the cause is unknown, it is more common in boys and low socioeconomic groups.
Physeal injuries
This document discusses physeal injuries in children. It begins by describing the anatomy of the physis, or growth plate. It then reviews several classification systems for physeal fractures, including the Salter-Harris classification which divides injuries into 5 types based on the location of the fracture line. The most common types and their typical prognosis are described. Treatment principles focus on anatomical reduction and immobilization to allow healing while preserving growth. Complications like premature growth arrest and angular deformities are risks, requiring long term monitoring.
perthes disease
This document provides an overview of Legg Calve Perthes disease, including its definition, demographics, risk factors, pathogenesis, clinical features, investigations, classifications, management, and surgical procedures. Some key points:
- It is avascular necrosis of the femoral head in children, most common in ages 4-8 years. Positive family history and low birth weight are risk factors.
- Clinical features include hip/thigh pain aggravated by movement. Imaging shows stages from avascular necrosis to fragmentation to regeneration/healing.
- Conservative management includes bracing for young/mild cases. Surgical containment is used for more severe/older cases to encourage spherical remodeling.
- Procedures
Proximal humerus fracture .pptx
proximal humerus fracture
presentation
introduction
epidemiology
classification
treament
complications
Femoro acetabular impingement syndrome
Femoro-acetabular impingement syndrome is a condition where the femoral head and acetabulum rub abnormally in the hip joint, causing damage. It is commonly caused by activities involving repetitive hip flexion, adduction, and internal rotation. Diagnosis involves physical exam maneuvers to reproduce pain and imaging to identify bony abnormalities and cartilage/labral damage. Common findings on x-ray include an alpha angle >70 degrees, coxa profunda, and crossover sign indicating retroversion. MRI can confirm labral tears or cartilage damage.
Hip Reduction Techniques
This document outlines techniques for reducing dislocated hips. It discusses various causes of hip dislocations including those from primary and revision total hip replacements, trauma, and hip resurfacing. Five techniques are described for reducing posterior hip dislocations: the Allis technique, Captain Morgan technique, Whistler technique, East Baltimore lift, and Stimpson method. Considerations for reduction include assessing other injuries, timing, and sedation. Post-reduction steps involve examining neurovascular status and imaging to check reduction. Complications can include nerve and artery injuries, fractures, and late issues like avascular necrosis.
Poller or blocking screw
Poller or blocking screws are used to stabilize fractures treated with small diameter intramedullary nails. They guide the nail like "poller" traffic devices guide vehicles. Blocking screws increase stability of distal and proximal metaphyseal fractures after nailing and can help manage malunited fractures. They work by narrowing the canal to guide the nail anteriorly and prevent sagittal plane deformity. Blocking screws are typically placed medially and laterally as close to the fracture as possible for optimal stabilization. Their placement on the concave side of deformities helps improve reduction by deflecting the nail.
Protrusio acetabuli
This document discusses protrusio acetabuli, a hip joint deformity where the medial wall of the acetabulum invades into the pelvic cavity. It can be caused by primary or secondary factors like infections, tumors, inflammation, trauma or genetics. The first case was described in 1824. Diagnosis involves clinical exams and radiological imaging. Treatment depends on the patient's age and bone maturity, and may include surgical closure of growth plates in children, bone grafting in adolescents, or total hip arthroplasty in older adults. Placement of the hip prosthesis component is important to avoid loosening.
Congenital scoliosis
Congenital scoliosis is caused by vertebral anomalies resulting in abnormal spinal growth in utero. It occurs in approximately 1 in 1000 live births. Evaluation of patients includes examination of the skin and neurological system as well as screening tests. Classification systems describe types of failures in vertebral formation and segmentation. Treatment depends on the severity and progression of the curve, ranging from bracing to gradual correction using growth-friendly techniques to acute correction through instrumentation and fusion surgery. Combined anterior and posterior surgery techniques aim to prevent crankshaft phenomenon while allowing for continued spinal growth.
Scoliosis examination
1) A thorough workup for scoliosis includes obtaining a detailed history, performing a physical examination, and ordering imaging studies. The history should include questions about deformity, pain, neurological symptoms, cardiopulmonary issues, and family history.
2) The physical examination evaluates posture, spinal alignment, and flexibility from multiple angles. It also evaluates the shoulders, ribs, pelvis, and for any neurological deficits.
3) Imaging studies like x-rays can further characterize the curve severity, skeletal maturity, and help determine a treatment plan. Together the history, exam, and imaging allow for an accurate diagnosis and clinical decision making.
Septic arthritis sequelae
This document discusses septic arthritis of the hip in children. It defines septic arthritis and notes that the hip is the most commonly infected joint in children. Early diagnosis and treatment is important to prevent joint damage. Signs include limping, groin pain, and limited hip movement. Treatment involves identifying the organism, administering sensitive antibiotics, and potentially surgery. Long term sequelae can include joint deformities, leg length discrepancies, and arthritis. Various classification systems and treatment approaches are presented. Prevention of septic arthritis through early diagnosis and management is emphasized.
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This document provides information on Legg Calve Perthes disease, including:
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- Its definition as osteonecrosis of the femoral epiphysis in children caused by non-genetic factors.
- Presentation, diagnosis using imaging like x-rays and MRI, and classifications of severity.
- Management involves containment of the femoral head through bracing, casting, or surgery depending on the stage and prognosis. The goal is to prevent secondary arthritis by achieving a spherical femoral head.
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Osteochondrosis is a defect in bone growth that causes avascular necrosis. It commonly affects the epiphyses of joints in children and adolescents. Some specific types discussed include Legg-Calve-Perthes disease of the hip, Kohler's disease of the navicular bone, and Freiberg's infraction of the metatarsal heads. The document outlines the causes, presentations, classifications, imaging findings, and treatment options for various forms of osteochondrosis.
Common childhood problems of the lower limb (cong. & dev.)
This document summarizes several congenital orthopedic conditions discussed in an orthopedics tutorial, including: developmental dysplasia of the hip, Perthes disease, recurrent dislocation of the patella, congenital talipes equinovarus (clubfoot), and syndactyly. For each condition, it describes the etiology, key features, diagnosis, and treatment approaches. Common causes of congenital orthopedic conditions include genetic disturbances, drugs, infections, trauma, anoxia, and compression in utero.
Picture quiz - chronic knee pain in an adolescent
A 13-year-old girl presented with right knee pain exacerbated by sports. Examination found normal knees but limited hip rotation. X-rays revealed slipped capital femoral epiphysis (SCFE), a hip condition where the femoral head slips off the neck. SCFE can be stable or unstable, with unstable types risking avascular necrosis. Prompt referral and screw fixation was needed to prevent further displacement and complications for this chronic, stable SCFE case.
Paediatric msk problems
Paediatric MSK problems
Signs and symptoms
MSK signs and symptoms:
Limp.
Joint pain and swelling.
Remember that hip pain may be referred to the knee.
Morning stiffness.
Gelling: stiffness following period of inactivity.
Weakness and instability.
Pseudoparalysis: limb fixed in pain.
Associated systemic symptoms:
Fever
↓Feeding or growth.
Rash.
Poor sleep.
History of trauma:
Incongruous signs might suggest non-accidental injury.
Functional limitations.
Differential diagnosis
General:
First exclude trauma – which may be missed/unwitnessed (especially in young e.g. toddler's fracture) – and infection – septic arthritis, osteomyelitis, or discitis.
Consider general causes of MSK pain such as growing pains (often nocturnal), hypermobility, and complex regional pain syndrome.
Acute: irritable hip, neuroblastoma, leukaemia.
Chronic: developmental dysplasia of the hip, talipes, cerebral palsy, juvenile idiopathic arthritis (JIA).
امراض مفصل الورك عند الاطفال- Pediatric hip البروفيسور فريح ابوحسان
امراض مفصل الورك عند الاطفال- Pediatric hip البروفيسور فريح ابوحسان Prof Freih Abu Hassan البروفيسور فريح ابوحسان
جراحة العظام / علاج العظام في الاردن / افضل دكتور عظام في الاردن / افضل اخصائي عظام في الاردن / استشاري عظام/افضل استشاري عظام في الاردن /جراحة عظام / /عمليات تطويل العظام في الاردن / اطباء العظام في الاردن / دكتور طب عظام في الاردن / الاطباء في الاردن / خلع ورك / عمليات اليزاروف في الاردن /علاج الكسور /خلع الولادة / تركيب المفصل / اوجاع العظام /افضل طبيب عظام اطفال في الاردن / استشاري اطفال عظام في الاردن / /علاج خلع الكتف / علاج التواء الكاحل / التواء الكاحل / علاج الام العظام / علاج هشاشة العظام / ارقام اطباء عظام في الاردن / مشاكل العظام والمفاصل /مستشار جراحة العظام والمفاصل والكسور/مستشار جراحة عظام الأطفال.
مفصل الورك عند الاطفال ، مرض بيرثز ،Legg's calve perthes disease
A 7-year-old boy presented with right groin pain and limping. He was diagnosed with Legg-Calvé-Perthes disease, which is avascular necrosis of the femoral head of unknown cause. It most commonly affects boys ages 4-12. The disease process involves bone death, fragmentation, and reossification of the femoral head, which can lead to deformities like flattening if not properly contained and allowed to heal. Treatment aims to relieve weight bearing and maintain range of motion to preserve the round femoral head shape during healing.
Approach to a child with hip pain
This document provides an overview of evaluating and diagnosing hip pain in children. It discusses taking a thorough history focused on distinguishing infectious, inflammatory, orthopedic, and neoplastic causes. The physical exam examines if the pain originates in or outside the hip joint and checks for signs of systemic disease. Initial tests are guided by findings, with imaging required if infection, injury, or tumor can't be ruled out. Common causes of hip pain in children include septic arthritis, transient synovitis, slipped capital femoral epiphysis, and Legg-Calvé-Perthes disease. The diagnostic and treatment approach depends on factors like the child's presentation and initial test results.
acute flacid paralysis approach-2.pptx
1. The document provides guidance on evaluating and diagnosing the cause of acute flaccid paralysis (AFP) in children.
2. It outlines the initial assessment priorities of respiratory, bulbar and cardiovascular evaluation.
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DevelopmentalDysplasiaHip
The document discusses developmental dysplasia of the hip (DDH), previously known as congenital hip dislocation. It covers normal hip development, causes of DDH, diagnosis, treatment including the Pavlik harness, and prognosis. DDH can be detected in newborns through clinical exams and worsens over time without treatment. Early reduction and stabilization of the hip is important for recovery and prevention of long-term issues.
Orthopedic surgery 9th pediatric orthopedic ( 1 )
This document discusses several pediatric orthopedic conditions, including developmental dysplasia of the hip (DDH), Legg-Calve-Perthes disease, and slipped capital femoral epiphysis (SCFE). DDH is an abnormal development of the hip joint that can range from dysplasia to dislocation. It is diagnosed through physical exam and imaging and treated with bracing or surgery. Legg-Calve-Perthes disease causes avascular necrosis of the femoral head and is most common in boys aged 4-8. SCFE involves slippage of the femoral epiphysis and is seen most often in obese adolescent males.
SCFE
This document discusses slipped capital femoral epiphysis (SCFE), a condition where the capital femoral epiphysis is displaced from the metaphysis through the physeal plate. It most commonly affects obese adolescents aged 10-16 years old. The causes are multifactorial and may include increased weight, femoral retroversion, endocrine disorders, and trauma. Clinically, patients present with groin or thigh pain and have a decreased range of motion on examination. Treatment options include non-operative measures like bed rest or traction or operative fixation with pins or screws to stabilize the epiphysis and promote physeal closure. The goals of treatment are to prevent further slippage and restore hip function without complications like avascular necrosis.
Slide show for paediatric trainees
The diagnosis is Turner syndrome. Some key risk factors include:
- Cardiac anomalies like bicuspid aortic valve and coarctation of the aorta, present in around 50% and 20% respectively. Early detection and management is important.
- Hypothyroidism, present in 10-30% of patients, requiring lifelong thyroid supplementation.
- Infertility due to gonadal dysgenesis. Spontaneous puberty and menses occur in only 20-25% and 2-5% respectively. Assisted reproductive technology may be the only option for biological children.
- Increased risk of diabetes, hypertension and metabolic syndrome later in life requiring lifestyle management and treatment.
- Reduced linear growth
Similar to legg calve Perthes disease (20)
Common childhood problems of the lower limb (cong. & dev.)
Common childhood problems of the lower limb (cong. & dev.)
امراض مفصل الورك عند الاطفال- Pediatric hip البروفيسور فريح ابوحسان
امراض مفصل الورك عند الاطفال- Pediatric hip البروفيسور فريح ابوحسان
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legg calve Perthes disease
- 1. Legg calve perthes disease By: Ala’a AlGhanem | 211508057 | B1
- 2. Learning Objectives: Normal anatomy of hip joint. Introduction and epidemiology Aetiology and classifications Clinical presentation Investigations Treatment and prognosis Complications
- 3. Anatomy of hip joint:
- 5. Legg calve perthes disease Idiopathic avascular necrosis of the proximal femoral epiphysis in children Legg Calve Perthes
- 6. Epidemiology: 2-Sex: 1-incidence: affects 1 in 1200 children > 5 : 1
- 7. 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)
- 8. the exact cause of disruption of blood supply remains unknown. Etiology: Associated conditions: -ADHD (33%) -delayed bone age (98%) -Thrombophilia (50%)
- 9. how Avascular necrosis (AVN) develops:
- 10. 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
- 11. Classifications: Waldenström Lateral Pillar (Herring ) Classification Catterall Classification Salter-Thompson classification Stulberg classification
- 12. Stages of Legg-Calves-Perthes (Waldenström) Initial stage (infarction) Fragmentation Reossification Healing or remodeling
- 13. Lateral Pillar (Herring ) Classification Determined at the beginning of fragmentation stage lateral pillar maintains full height Maintains >50% height Maintains <50% height
- 14. Catterall Classification Based on degree of head involvement
- 15. Salter-Thompson classification Based on radiographic cresent sign crescent sign involves < 1/2 of femoral head crescent sign involves > 1/2 of femoral head Class A Class B
- 16. 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
- 17. 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:
- 18. 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)
- 19. 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
- 20. Differential Diagnosis multiple epiphyseal dysplasia spondyloepiphyseal dysplasia sickle cell disease Gaucher disease hypothyroidism Meyers dysplasia
- 21. 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.
- 22. 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
- 24. 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.
- 25. Pelvic osteotomy: Dega Osteotomy Salter (Innominate) Osteotomy
- 26. Femoral osteotomy: Varus femoral osteotomy
- 27. 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
- 28. 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.
- 29. References: Johns Hopkins Pediatric Orthopaedics Patient
- 30. Thank You