legge calve perthese disease - mums.ac.ir · 2015. 2. 14. · clinical features of...
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Legge – Calve – Perthese disease
S.M. Mazloumi
Associate professor in orthopedics
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Legg- Calve – Perthes disease
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Anatomy
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Acetabular retroversion
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Etiology of Legg-Calve-Perthes Disease
Factors That May Be Etiologic • Trauma • Susceptible child • Hereditary factors • Coagulopathy • Hyperactivity • Passives moking Factors Unlikely To Be Etiologic • Endocrinopathy • Urban environment • Synovitis
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Clinical Features of Legg-Calve-Perthes Disease
• Onset: between 18months of age and
skeletal maturity (most prevalent between 4
and 12years of age)
• Male sex prevalence: the disease is four or
five times more likely to develop in boys than
in girls
• Involvement:
bilateral in 10%to 12% of patients
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Clinical Features of Legg-Calve-Perthes Disease
Symptoms
-limp that is exacerbated by activity and alleviated with rest
-pain, which may be located in the groin,anterior hip region, medial knee joint or laterally around the greater Trochanter
- history of antecedent trauma
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Clinical Features of Legg-Calve-Perthes Disease
Signs
- Abductor limp
- Decreased range of motion of the hip, especially on abduction and internal rotation
- Flexion/extension less affected
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Symptoms and Signs of Legg-Calve- Perthes Disease
Symptoms • Limping • Hip pain • Knee pain • History of trauma (?) Signs • Limp • Decreased hip range of motion • Spasm of long muscle around hip joint
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Pathologic Findings of Legg-Calve- Perthes Disease
Early Stage • Dead trabecular bone , Collapsed trabeculae • Thickened articular cartilage , Physeal disruption • Cartilage extending from the physis into the
metaphysis Fragmentation Stage • Invasion of vascular granulation tissue • New bone forming on old trabeculae • Woven new bone formation Healing Stage • New bone, woven and lamellar • Return to normai architecture
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Differential Diagnosis for Legg-Calve- Perthes Disease
Other Causes of Avascular Necrosis
• Sickle cell disease
• Other hemoglobinopathies
• Thalassemia
• Steroid medication
• After traumatic hip dislocation
• Treatment of developmental dysplasia of
• the hip
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Differential Diagnosis for Legg-Calve- Perthes Disease
Epiphyseal Dysplasias
• Muitiple epiphyseal dysplasia
• Spondyloepiphyseal dysplasia
• Mucopolysaccharidoses
• Hypothyroidism
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Differential Diagnosis for Legg-Calve- Perthes Disease
Other Syndromes
• Osteochondromatosis
• Metachondromatosis
• Schwartz-Jam pel syndrome
• Trichorhinophalangeal syndrome
• Maroteaux-Lamy syndrome
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Caterall classification
• Group I, partial head or less than half head involvement;
• Groups II and III, more than half head involvement and sequestrum formation
• Group IV, involvement of the entire epiphysis
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Lateral pillar classification
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Imaging Evaluation
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Imaging Evaluation
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X-Ray
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Imaging Evaluation
• MRI
• Bone scan
• Arthrography
• X-ray
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Treatment
The primary aim of treatment of Legg-Calv-Perthes disease is containment of the femoral head within the acetabulum
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Bracing
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Bracing
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Varus Derotational Osteotomy
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Proximal femoral varus osteotomy
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Proximal femoral valgus osteotomy
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Valgus osteotomy
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Triple ost.
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Shelf acetabuloplasty
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Chiari osteotomy
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Triple pelvic osteotomy
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Double-level osteotomy
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Greater trochanteric advancement
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Treatment
1. Most patients can be treated by noncontainment methods and obtain good results (84%). 2. Satisfactory clinical results frequently can be obtained at long-term follow-up despite an unsatisfactory radiographic appearance (nine hips). 3. The Catterall classification is a valid indicator of results, but is not applicable as a therapeutic guide for an average of 8.1 months after onset
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Treatment
4. Head-at-risk signs added little to the Catterall classification as a prognostic indicator or therapeutic guide. 5. All of the fair and poor results were in patients with Catterall III or IV involvement and onset of the disease at age 6 or older. (A Catterall III or IV classification is equivalent to Herring groups B and C.)
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Scott – Schlatter disease
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Scott – Schlatter disease
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