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%

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

1. Toxic synovitis
2. SCFE
3. Acute rheumatic fever
4. Tuberculosis arthritis
5. Malignancy

Treatment

1. Non-weight bearing
2. Referral to ortho

See Also

Hip Pain (Peds)

Source

Tintinalli