Legg-Calve-Perthes disease: Difference between revisions
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==Clinical Features== | ==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 | ||
| Line 19: | Line 19: | ||
*Initial radiographs may be normal | *Initial radiographs may be normal | ||
**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 | ||
Revision as of 22:03, 24 December 2016
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
- Initial radiographs may be normal
- 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
- Non-weight bearing
- Referral to ortho