Legg-Calve-Perthes disease

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:
  • Appendicitis
  • Meningitis
  • Epidural abscess (spinal)

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

1. Non-weight bearing
2. Referral to ortho

See Also

• Pediatric hip pain