Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Legg calve perthes disease

3,006 views

Published on

LEGG CALVE PERTHES DISEASE

Published in: Health & Medicine
  • Be the first to comment

Legg calve perthes disease

  1. 1. DR VANDANA G HARI RESIDENT KIMS TRIVANDRUM
  2. 2. Painful disorder of childhood characterised by avascular necrosis of femoral capital epiphysis. -Osteochondritis deformans juvenilis/Coxa plana -described 1910 independently by Legg, Calve, Perthes ,Waldenstrom Legg Calve Perthes Disease
  3. 3. Pathogenesis   Precipitating cause unknown  Predisposing factors  -Genetic aspects 2-20%  -Abnormal growth & development ,bone age <1-3yrs  Poor socio economic status  -Inherited thrombophilia  -Males 4:1  -Trauma
  4. 4.  Cardinal cause ISCHEMIA OF FEMORAL HEAD  4-7yrs femoral head depend on lateral epiphyseal vessels(.upto 4 metphysea later ligamentum teres)  Epiphyseal vessels susceptible to stretching & pressure   Effusion
  5. 5.  Venous flow blocked  Venous stasis  Intraosseous pressure rises   Ischemia
  6. 6. Stages of Legg-Calves- Perthes (Waldenström  Initial -infarction produces a smaller, sclerotic epiphysis with medial joint space widening -radiographs may remain occult for 3 to 6 mos
  7. 7.  Fragmentation  Dead marrow replaced with granulation tissue  Bone revascularised  Some dead fragments replaced by fibrous tissue  Alternating areas of sclerosis &fibrosis – Fragmentation of epiphysis  Hyperemic metaphysis-Rarefied / cystic in X- ray-hip related symptoms are most prevalent -lateral pillar classification based on this stage
  8. 8. • Reossification -ossific nucleus undergoes reossification as new bone appears as necrotic bone is resorbed  -may last up to 18m
  9. 9.  Healing or remodeling -femoral head remodels until skeletal maturity  -begins once ossific nucleus is completely reossified trabecular patterns return  Rapid &complete repair- architecture maintained  Tardy epiphysis collapse –Distorted growth of Head and Neck  Head Oval flattened head of mushroom  Neck shor t and broad
  10. 10. Clinical Features  -Classical presentation  Painless limp (4-8yr old boy)  -Pain a/c or insidious –vague ,ache in groin, thigh or knee, aggravated by hip movements
  11. 11.  Signs  1.Antalgic gait  2.Muscle spasm  3.Limited abduction & internal rotation  4.Proximal thigh atrophy  5. Trendelenburg gait (head collapse leads to decreased tension of abductors
  12. 12. Radiology Decreased size of left femoral capital epiphysis  Linear translucency .wide joint space
  13. 13. Subchondral fracture
  14. 14. Small left femoral cap.epiphysis Wide neck Widened articular surface Linear translucency CRESCENT SIGN
  15. 15. •Acetab ular change •widene d right femoral neck •smaller, sclerotic, flattened femoral subcapital epiphysis
  16. 16. Metaphyseal cyst rt.
  17. 17. In group I there is involvement (hatched areas) of the anterior head only, no sequestrum, and no collapse of the epiphysis. In group II, only the anterior head is involved, and there is a sequestrum with a clear junction. In group III only a small part of the epiphysis is not involved. In group IV there is total head involvement CATERALL CLASSIFICATION
  18. 18. Gp 3 & 4 ◦ Head at risk signs (indicate a more severe disease course)  Gage sign  V-shaped radiolucency in the lateral portion of the epiphysis and/or adjacent metaphysis  calcification lateral to the epiphysis  lateral subluxation of the femoral head  Horizontal growth plate
  19. 19. Gage sign Lateral subluxation
  20. 20. Salter Thompson  GP A :<1/2 of capital femoral epiphysis involved  Gp B: >1/2 involved
  21. 21. Herring Classification  Femoral head : 3 pillars by lines at medial and lateral edge of central sequestrum  A : Normal ht of lateral pillar  B: Partial prolapse >50% ht  C: Severe prolapse<50%ht
  22. 22. Other investigations  Bone scan ◦ can confirm suspected case of LCP ◦ decreased uptake (cold lesion) can predate changes on radiographs  MRI ◦ can provide early diagnosis revealing alterations in the capital femoral epiphysis and physis  Arthrogram ◦ a dynamic arthrogram can demonstrate coverage and containment of the femoral head
  23. 23. Treatment  The primary aim Containment of head with in acetabulam  Initial management:  1. analgesia  2.modification of activities  3.preservation of abduction  Reassess
  24. 24. Containment Holding hip widely abducted • Newington brace,Toronto,Petri cast, Scottish Rite
  25. 25. Surgical procedures VARUS DEROTATIONAL OSTEOTOMY –to provide containment
  26. 26. Reconstructive Procedures  Cheiloctomy –removal of protuberance  Chiari osteotomy-deepens acetabulam by medial displcement of distal pelvic fragment  Trocanteric advancement-distal transfer to normalise tension of trocanteric muscles
  27. 27. Guidelines Children under 6  Symptomatic treatment
  28. 28. 6-8yrs Bone age <=6yrs LP A&B: symptomatic treatment LP C: Ab.brace Bone age >6yrs A&B : Ab.brace/Oste otomy LP C:unaffected by treatment
  29. 29. >9yrs  Operative containment
  30. 30.  Thank u

×