Orthopedics Book

http://www.fpnotebook.com/

Legg-Calve-Perthes

Aka: Legg-Calve-Perthes, Aseptic Necrosis of the Femoral Head, Perthes Disease, Legg-Calve-Perthes Disease
Advertisement
  1. See Also
    1. Pediatric Limp
    2. Osteochondrosis
  2. Epidemiology
    1. Children age 4-9 years old
    2. Boys affected 4-5 times more often than girls
    3. Familial in 20% of cases
    4. Incidence 1:1000 to 1:5000
    5. Typical body habitus
      1. Short to average height
      2. Average weight to Overweight (but not typically obese as seen in Slipped Capital Femoral Epiphysis)
  3. Risk Factors
    1. Boys
    2. Low birth weight
    3. Abnormal birth presentation (e.g. Breech Presentation)
    4. Family History
    5. Higher birth order
    6. Lower socioeconomic status
  4. Pathophysiology
    1. Juvenile idiopathic avascular necrosis of femoral head
      1. Results from a partial interruption of the blood supply to the femoral head
      2. Repeat episodes result in infarction and necrosis of the femoral head
      3. Subchondral Stress Fractures with remodeling over ensuing 2-4 years
      4. Femoral head flattens and subluxes
  5. Etiology
    1. Idiopathic Osteochondrosis
  6. Symptoms
    1. Pain in area of hip and may be referred to knee
    2. Unilateral Hip Pain in 90% of cases
    3. Insidious onset of pain
  7. Signs
    1. Child walks with a limp
    2. Decreased hip range of motion
      1. Limited hip abduction
      2. Limited internal rotation
    3. Leg Length Discrepancy
  8. Imaging
    1. Views
      1. Anteroposterior Pelvis
      2. Frog-leg lateral hip
    2. Findings
      1. Joint space widening
      2. Proximal femur growth center with fragmentation, flattening, and sclerosis
        1. May demonstrate a subchondral Stress Fracture line
  9. Differential Diagnosis
    1. Septic Hip
    2. Transient Hip Synovitis
    3. Proximal femur Osteomyelitis
  10. Management
    1. Orthopedic consultation in all cases
    2. Difficult management
      1. Long-term treatment
      2. Limited activity
    3. Bracing and Casting for up to 1-2 years
    4. Surgical reconstruction to improve Hip Joint congruity
      1. Allows child back to activity in 4-6 months
  11. Complications
    1. Severe degenerative hip disease
      1. Requires hip replacement by middle age in 50% cases
    2. Proximal thigh atrophy and limb shortening
  12. Prognosis
    1. Fair at best to avoid longterm arthritis (see complications above)
    2. Best prognosis for optimal range of motion is with early treatment at young age
    3. Predictors of worse prognosis
      1. Age over 6 years at onset of condition
      2. More severely affected femoral head deformity
      3. Hip Joint incongruity
      4. Decreased hip range of motion
  13. References
    1. Claudius and Behar in Majoewsky (2012) EM:RAP-C3 2(8): 1
    2. Atanda (2011) Am Fam Physician 83(3): 285-91
    3. Wiig (2008) J Bone Joint Surg Br 90(10): 1364-71

Legg-Calve-Perthes Disease (C0023234)

Definition (NCI) A very rare disorder of unknown etiology affecting children. It is characterized by avascular necrosis of the femoral head.
Definition (MSH) A particular type of FEMUR HEAD NECROSIS occurring in children, mainly male, with a course of four years or so.
Concepts Disease or Syndrome (T047)
MSH D007873
ICD10 M91.2, M91.3
SnomedCT 15739006, 111255008, 240169001, 203371007, 203372000, 203367009, 240241003, 156817009, 270545000
English Coxa Plana, Disease, Perthes, Legg Perthes Disease, Perthes Disease, Disease, Legg-Perthes, Perthes' disease, COXA PLANA, LEGG-CALVE-PERTHES SYNDROME, OSTEOCHONDROSIS, CAPITAL FEMORAL EPIPHYSIS, Juvenile osteochondrosis of head of femur, Legg Calve Perthes Disease, Perthe's disease, Perthe's disease of hip, Perthes disease - osteochondritis of the femoral head, coxa plana, LEGG-PERTHES DISEASE, LEGG-CALVE-PERTHES DISEASE, PERTHES DISEASE, LEGG PERTHES DIS, PERTHES DIS, Perthes' dis. (femoral head), Perthes' disease - osteochondritis of the femoral head, Legg Calve Perthes disease, Legg Perthes disease, LCPD, LCP, Legg-Perthe's disease (diagnosis), Legg-Perthe's disease, Perthe's disease (disorder), (Perthes' disease) or (Coxa plana) (disorder), Legg Calvé Perthes Syndrome, Legg-Calvé-Perthes Syndrome, Syndrome, Legg-Calvé-Perthes, Disease, Legg-Calve-Perthes, Legg-Perthes Disease [Disease/Finding], disease legg calve perthe, perthes' disease, disease legg perthe, disease leggs perthes, disease perthes's, legg-perthes disease, Disease;Calve-Perthes, disease legg calves perthe, legg calve perthe disease, legg calve perthes disease, perthes legg disease, calve disease legg perthes, disease legg calves perthes, legg perthe disease, legg perthes disease, calve diseases legg perthes, disease legg calve perthes, legg perthes calve disease, legg-calve-perthes disease, perthe's disease, calve disease legg perthe, disease perthes, legg-calve-perthes syndrome, perthes disease, disease legg-calve-perthes, perthe disease, Osteochondritis Deformans, Legg-Calvé-Perthes Disease, Syndrome, Legg-Calve-Perthes, Disease, Legg-Calvé-Perthes, Legg Calve Perthes Syndrome, Legg-Perthes Disease, Legg-Calve-Perthes Syndrome, Osteochondritis Deforman, Legg Calvé Perthes Disease, Legg-Calve-Perthes Disease, Coxa plana, Legg-Calve-Perthes disease, Pseudocoxalgia, Coxa plana (disorder), pseudocoxalgia, Legg-Perthes, coxa; plana, Perthes, epiphysis; juvenile osteochondrosis head of femur, femoral capital epiphysis; osteochondrosis, head of femur; juvenile osteochondrosis, head of femur; osteochondrosis, juvenile, Calve-Perthes, Calvé-Perthes, osteochondrosis; femoral capital epiphysis, osteochondrosis; juvenile, head of femur, plana; coxa, Calve - Perthes' disease, (Perthes' disease) or (Coxa plana), Legg-Calvé-Perthes disease, Osteochondrosis of Legg-Calve-Perthes, Calve-Perthes disease
Dutch ziekte van Perthes, coxa; plana, epifyse; juveniele osteochondrose femurkop, femurkop-epifyse; osteochondrose, femurkop; juveniele osteochondrose, femurkop; osteochondrose, juveniel, osteochondrose; femurkop-epifyse, osteochondrose; juveniel, femurkop, plana; coxa, Coxa plana, Pseudocoxalgie
French Maladie de Perthe, Ostéochondrite juvénile de la tête fémorale, Ostéochondrite juvénile de la tête du fémur, Coxa plana, Arthrite déformante juvénile, Maladie de Legg-Calvé-Perthes, Maladie de Legg-Perthes, Maladie de Legg, Maladie de Perthes, Ostéochondrite déformante juvénile de la hanche, Ostéochondrite primitive de la hanche, Épiphysite fémorale supérieure
German Morbus Perthes, Pseudokoxalgie, Coxa plana, Legg-Perthes-Krankheit, Perthes-Krankheit
Italian Malattia di Perthes, Malattia di Legg-Perthes
Swedish Legg-Perthes sjukdom
Japanese ﾍﾟﾙﾃｽﾋﾞｮｳ, レッグ･カルベ･ペルテス病, Perthes病, Legg-Perthes病, ペルテス病, レッグ-ペルテス病, 扁平股, 若年性変形性骨軟骨炎, レッグ-カルヴェ-ペルテス病
Czech Calvého-Leggova-Perthesova nemoc, coxa plana, Leggova-Perthesova nemoc, Perthesova nemoc
Spanish Perthe's disease, (Perthes' disease) or (Coxa plana), Coxa plana, Legg-Calve-Perthes disease, Perthes' disease - osteochondritis of the femoral head, Calve - Perthes' disease, Pseudocoxalgia, coxa plana (trastorno), coxa plana, enfermedad de Legg - Calvé - Perthes, enfermedad de Perthes, osteocondritis deformante juvenil, seudocoxalgia, Enfermedad de Perthes, Coxa Plana, Enfermedad de Legg-Perthes
Finnish Legg-Calvé-Perthesin tauti
Russian LEGGA-KAL'VE-PERTESA BOLEZN', LEGGA-PERTESA BOLEZN', TAZ PLOSKII, PERTESA BOLEZN', ЛЕГГА-КАЛЬВЕ-ПЕРТЕСА БОЛЕЗНЬ, ЛЕГГА-ПЕРТЕСА БОЛЕЗНЬ, ПЕРТЕСА БОЛЕЗНЬ, ТАЗ ПЛОСКИЙ
Korean 납작엉덩관절(편평고), 가성 엉덩관절통(증)
Croatian LEGG-PERTHESOVA BOLEST
Polish Choroba Calvego Legga i Perthesa, Złuszczenie głowy kości udowej młodzieńcze, Samoistna martwica głowy kości udowej, Choroba Perthesa, Osteochondroza młodzieńcza głowy kości udowej, Jałowa młodzieńcza martwica głowy kości udowej, Choroba Legga-Perthesa
Hungarian Perthes-betegség
Portuguese Coxa Plana, Doença de Legg-Perthes, Doença de Perthes
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Avascular necrosis of the capital femoral epiphysis (C1442965)

Concepts Disease or Syndrome (T047)
SnomedCT 111255008, 15739006
English Perthes disease of hip, Perthes disease, Avascular necrosis of the capital femoral epiphysis, Avascular necrosis of the capital femoral epiphysis (disorder)
Spanish necrosis aséptica de la epífisis de la cabeza del fémur, necrosis avascular de la epífisis de la cabeza femoral (trastorno), necrosis avascular de la epífisis de la cabeza femoral
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Navigation Tree