Legg-Calve-Perthes disease: Difference between revisions

Revision as of 06:21, 27 June 2011

Background

Avascular necrosis of femoral head
- Capital femoral epiphysis fails to grow because of lack of blood supply
Affects children 4-9yr old
Male:female 4:1
Bilateral in 10%

Diagnosis

Clinical Presentation

Insidious onset of mild hip pain and limp
- May have painless limp
- May have referred pain to groin, thigh, knee
Pain often exacerbated by activity, relieved w/ rest
Decreased hip abduction and internal rotation

Imaging

Initial radiographs may be normal
- If high suspicion obtain bone scan or MRI
Findings
- Widening of cartilage space of affected hip
- Small size ossific nucleus of femoral head
- Subchondral stress fracture line in femoral head

DDX

Toxic synovitis
SCFE
Acute rheumatic fever
Tuberculosis arthritis
Malignancy

Treatment

Non-weight bearing
Referral to ortho

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-* ischemic necrosis of femoral head
+*Avascular necrosis of femoral head
-* exact mech unknown
+**Capital femoral epiphysis fails to grow because of lack of blood supply
-* more common in boys
+*Affects children 4-9yr old
-* 10% of cases occur bilaterally
+*Male:female 4:1
-* inc 1 per 1200 - 12,000
+*Bilateral in 10%
 ==Diagnosis==
-*Age - 4 to 9 yrs
+===Clinical Presentation===
-*Present - Painless Limp
+*Insidious onset of mild hip pain and limp
-*Labs - normal
+**May have painless limp
-*Xrays - Compression, collapse, fragmentation
+**May have referred pain to groin, thigh, knee
+*Pain often exacerbated by activity, relieved w/ rest
+*Decreased hip abduction and internal rotation
+===Imaging===
+*Initial radiographs may be normal
+**If high suspicion obtain bone scan or MRI
+*Findings
+**Widening of cartilage space of affected hip
+**Small size ossific nucleus of femoral head
+**Subchondral stress fracture line in femoral head
-===Presentation===
+==DDX==
-* classically a painless limp
+#Toxic synovitis
-* may have mild, intermittent pain in hip, groi, thigh or knee
+#SCFE
-* pain often activiity related & relieveed by rest.
+#Acute rheumatic fever
+#Tuberculosis arthritis
-===Physical Exam===
+#Malignancy
-* decr range of motion, esp internal rotation and abduction.
-* may have leg length discrepancy Xrays
-* initially show increase in articular space or compression of bone
-* as necrosis progresses, epiphysis will collapse and fragment
 ==Treatment==
-# "Containment" by external orthoses, for up to 18 mo or surgery
+#Non-weight bearing
-# 50% of untreated get disabling arthritis
+#Referral to ortho
-# younger diagnosed, better prog
 ==See Also==
 [[Hip Pain (Peds)]]
+==Source==
+Tintinalli
 [[Category:Peds]]
 [[Category:Ortho]]