Legg-Calve-Perthes disease: Difference between revisions
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==Background== | ==Background== | ||
*Avascular necrosis of femoral head | *[[Avascular necrosis of hip|Avascular necrosis of femoral head]] | ||
**Capital femoral epiphysis fails to grow because of lack of blood supply | **Capital femoral epiphysis fails to grow because of lack of blood supply | ||
*Affects children 4-9yr old | *Affects children 4-9yr old | ||
| Line 6: | Line 6: | ||
*Bilateral in 10% | *Bilateral in 10% | ||
==Clinical Features== | |||
*Insidious onset of mild hip pain and limp | *Insidious onset of mild [[hip pain]] and [[limp]] | ||
**May have painless limp | **May have painless limp | ||
**May have referred pain to groin, thigh, knee | **May have referred pain to groin, thigh, knee | ||
*Pain often exacerbated by activity, relieved | *Pain often exacerbated by activity, relieved with rest | ||
*Decreased hip abduction and internal rotation | *Decreased hip abduction and internal rotation | ||
| Line 16: | Line 16: | ||
{{Pediatric hip DDX}} | {{Pediatric hip DDX}} | ||
== | ==Evaluation== | ||
[[File:Roe-perthes.jpg|thumb|]] | |||
* | *Plain radiographs of the hip | ||
**May be normal early in disease | |||
**If high suspicion obtain bone scan or MRI | **If high suspicion obtain bone scan or MRI | ||
* | *Imaging findings: | ||
**Widening of cartilage space of affected hip | **Widening of cartilage space of affected hip | ||
**Small size ossific nucleus of femoral head | **Small size ossific nucleus of femoral head | ||
**Subchondral stress fracture line in femoral head | **Subchondral stress fracture line in femoral head | ||
== | ==Management== | ||
*Orthopedic surgery consultation | |||
*Non-weight bearing | |||
*Protection of hip joint (maintain in abduction and internal rotation) | |||
==Disposition== | |||
*Generally may be discharged | |||
**Should be done in consultation with orthopedic surgery to ensure appropriate therapy and close follow-up | |||
==See Also== | ==See Also== | ||
*[[Pediatric hip pain]] | *[[Pediatric hip pain]] | ||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Pediatrics]] | ||
[[Category: | [[Category:Orthopedics]] | ||
Latest revision as of 22:09, 23 August 2019
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%
Clinical Features
- 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 with rest
- Decreased hip abduction and internal rotation
Differential Diagnosis
Pediatric limp
Hip Related
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Other Causes of Limping
- Developmental dysplasia
- Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
- Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
- Osteomyelitis
- Myositis
- Other:
Evaluation
- Plain radiographs of the hip
- May be normal early in disease
- If high suspicion obtain bone scan or MRI
- Imaging findings:
- Widening of cartilage space of affected hip
- Small size ossific nucleus of femoral head
- Subchondral stress fracture line in femoral head
Management
- Orthopedic surgery consultation
- Non-weight bearing
- Protection of hip joint (maintain in abduction and internal rotation)
Disposition
- Generally may be discharged
- Should be done in consultation with orthopedic surgery to ensure appropriate therapy and close follow-up