scholarly journals Legg-Calvé-Perthes disease: Diagnostics and contemporary treatment

2008 ◽  
Vol 136 (7-8) ◽  
pp. 430-434 ◽  
Author(s):  
Zoran Vukasinovic ◽  
Cedomir Vucetic ◽  
Dusko Spasovski ◽  
Zorica Zivkovic
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Pelvic Osteotomy ◽  
Vascular Supply ◽  
Perthes Disease ◽  
Endocrine Disturbances ◽  
Disease Diagnostics ◽  
Innominate Osteotomy ◽  
Femoral Shortening ◽  
Slight Limitation

Legg-Calv?-Perthes disease represents avascular necrosis of the femoral head in a growing child. It commonly affects children aged 2-14 years, mostly boys, and has familiar pattern. The etiology of this disease is unknown. It is based on avascular necrosis due to variations of the femoral head vascular supply, trauma, coagulation of endocrine disturbances. The disease presents with limping and pain localized in the hip with projection to thigh and knee, frequently accompanied by the limitation of abduction and internal rotation, as well as slight limitation in flexion of about 20 degrees. Plain radiography is most informative additional diagnostic procedure, enabling assessment of the stage of disease, containment of the femoral head within the acetabulum, acetabular coverage and the extent of disease. Main treatment goal is obtaining the spherical congruity of the hip joint. This can be achieved by abduction bracing, varization femoral osteotomies and various innominate osteotomies (sometimes combined with femoral osteotomies). Children younger than four years of age, with minimal femoral head involvement, do not need any treatment. These children with a larger involvement, older than four years of age, with possible containment in hip abducion, should be treated by one of the following procedures: Salter innominate osteotomy, Salter innominate osteotomy with femoral shortening, or triple pelvic osteotomy. The patients with containment of the hip is not possible in abduction (related to subluxation and femoral head crush), should be treated by Chiari pelvic osteotomy.

Legg-Calvé-Perthes Disease

1986 ◽  
Vol 7 (10) ◽  
pp. 299-304
Author(s):  
William P. Bunnell
Keyword(s):  
Birth Weight ◽  
Femoral Head ◽  
Vascular Supply ◽  
Skeletal Age ◽  
Perthes Disease ◽  
Unknown Etiology ◽  
Necrotic Bone

Perthes disease is a condition of unknown etiology in which the vascular supply of the developing femoral head is temporarily interrupted, causing necrosis and collapse of the bony femoral head, followed by spontaneous revascularization and healing of the necrotic bone. It was independently described by four different authors (Legg, Calvé, Perthes, and Waldenstrom) in 1909 and 1910. They identified the condition as an affliction of the hip distinct from trauma and infection. The term "coxa plana" was applied to the characteristic flattening of the femoral head seen in Perthes disease. It was not until 10 years later that the actual pathology of avascular necrotic bone was described. EPIDEMIOLOGY The condition has its onset in children ranging in age from 2 to 12 years, with the majority of patients presenting between the ages of 4 and 8 years. Boys are affected four times more frequently than girls, and the condition is bilateral in approximately 15% of affected children. Certain constitutional factors are frequently found in children with Perthes disease. Skeletal age is delayed in nearly 90% of children affected with it. Affected boys have been found to be an average of 1 in shorter and affected girls 3 in shorter in height than their unaffected peers. Birth weight of affected children is frequently lower than average.

scholarly journals PELVIC OSTEOTOMY IN THE COMPLEX TREATMENT OF CHILDREN WITH LEGG-CALVE-PERTHES DISEASE

2014 ◽  
Vol 2 (2) ◽  
pp. 29-37
Author(s):  
Dmitry Borisovich Barsukov ◽  
Mikhail Mikhailovich Kamosko
Keyword(s):  
Femoral Head ◽  
Survey Data ◽  
Hip Joint ◽  
Pelvic Osteotomy ◽  
Perthes Disease ◽  
Complex Treatment ◽  
Bone Coverage ◽  
Research Institute

At the Scientific and Research Institute for Children’s Orthopedics n. a. G. I. Turner we analyzed survey data of 120 patients aged from 6 to 14 years old with Legg-Calve-Perthes disease with severe epiphysis deformation, in order to improve the outcomes. All patients underwent reconstructive (remodeling) surgery - a corrective hip osteotomy, a pelvic osteotomy by Salter, a combination of these techniques and a triple pelvic osteotomy. Postoperative follow-up period averaged 10 years. It is shown that pelvic osteotomy is an operation of choice for Legg-Calve- Perthes disease along with corrective hip osteotomy, and remodeling of the femoral head is only possible when the degree of bone coverage is equal to one or more. We highlighted radioanatomical structure of the affected hip joint, allowing to precise indications for surgical remodeling type of femoral head.

scholarly journals Legg-Calve-Perthes Disease: A Rare Cause of Bilateral Avascular Necrosis of the Hip Joints

2013 ◽  
Vol 4 (1) ◽  
pp. 40-41
Author(s):  
Quazi Tarikul Islam ◽  
Mahmudur Rahman Siddiqui ◽  
Ekramul Mustafa ◽  
Ahmed Hossain ◽  
Md Yousuf Ur Rahman ◽  
...  
Keyword(s):  
Femoral Head ◽  
Early Detection ◽  
Avascular Necrosis ◽  
Typical Case ◽  
Perthes Disease ◽  
Clinical Correlation ◽  
Hip Joints ◽  
X Ray ◽  
Relieve Pain

Perthes' disease is a disorder of the hip joint in children. Femoral head became softens, flattened or deformed because of the lack of blood supply of unknown cause. It is a very rare cause of bilateral avascular necrosis of the head of the femur, which can easily diagnosed by clinical correlation with the X-ray pelvis findings. Here we present a typical case of Perthes disease, who was finally diagnosed after a long periods of time. In Perthes disease early detection is very important to preserve, restore the femoral head, relieve pain and prevent long term osteoarthritis. DOI: http://dx.doi.org/10.3329/akmmcj.v4i1.13684 AKMMC J 2013: 4(1): 40-41  

scholarly journals REHABILITASI MEDIK PADA PENYAKIT LEGG-CALVÉ-PERTHES

2014 ◽  
Vol 6 (2) ◽  
Author(s):  
René R. Pradnasurya ◽  
Engeline Angliadi
Keyword(s):  
Femoral Head ◽  
Physical Examination ◽  
Avascular Necrosis ◽  
Clinical Symptoms ◽  
Knee Extensor ◽  
Perthes Disease ◽  
X Ray ◽  
Muscle Strengthening ◽  
Infra Red ◽  
The Right

Abstract: In Legg-Calvé-Perthes disease there is an avascular necrosis condition of the femoral head with a clinical onset between the ages of 2-12 years old.  The etiology of this disease remains unknown. Its variable clinical symptoms and disease progression depend on the severity of the disease. The principle of therapy is hip containment. Rehabilitation programs play an important role to revert or to maximize the function and activities of daily living. We reported a case of a 9-year-old girl with complains of limpness, asymmetric lower extremities, weakness of the right lower extremity, pain around the right knee, with a history of trauma on the right hip 5 months ago. Physical examination revealed weakness of the right hip flexor and knee extensor with limitation of the right hip’s range of motions. The X-ray taken showed an avascular necrosis appearance at the right femoral head. Conclusion: This case was diagnosed as Legg-Calvé-Perthes disease based on anamnesis, physical examination, and the X-ray result. The rehabilitation management for this case was heat modality with infra red to prepare the muscle condition for exercises, muscle strengthening and range of motion exercises to prevent contracture, as well as medical education with psychological support.  Scottish Rite orthosis was planned to position the hip in abduction while limiting the hip adduction. Keywords: Legg-Calvé-Perthes, avascular necrosis, comprehensive rehabilitation.   Abstrak: Pada penyakit Legg-Calvé-Perthes terjadi kondisi nekrosis avaskular kaput femur dengan usia awitan paling sering antara usia 2-12 tahun. Etiologi penyakit ini masih belum diketahui, dengan perjalanan dan gambaran klinis yang bervariasi tergantung dari tingkat keparahan penyakit. Prinsip terapi penyakit ini ialah hip containment. Program rehabilitasi diberikan secara komprehensif baik dari fisioterapi, terapi okupasi, ortotik-prostetik, psikologi, serta sosial medik yang sangat berperan dalam mengembalikan atau memaksimalkan fungsi dan aktivitas kehidupan sehari-hari. Kami melaporkan kasus seorang anak perempuan usia 9 tahun dengan keluhan berjalan pincang, asimetris antara tungkai kanan dan kiri, kelemahan tungkai kanan, nyeri sekitar lutut kanan, dengan riwayat trauma panggul kanan 5 bulan lalu. Pada pemeriksaan fisik ditemukan kelemahan otot fleksor panggul dan ekstensor lutut kanan serta keterbatasan lingkup gerak sendi panggul kanan. Pada pemeriksaan radiologik terlihat gambaran nekrosis avaskular kaput femur kanan. Simpulan: Pada kasus ini, diagnosis penyakit Legg-Calvé-Perthes ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan pemeriksaan radiologik. Penanganan rehabilitasi yang diberikan ialah modalitas panas berupa sinar infra red untuk mempersiapkan kondisi otot sebelum latihan, latihan penguatan otot dan lingkup gerak sendi untuk mencegah kontraktur, serta edukasi baik dari sisi medik maupun psikologik. Juga direncanakan pemberian Scottish Rite orthosis untuk membuat posisi panggul menjadi abduksi dengan membatasi gerakan adduksi. Kata kunci: Legg-Calvé-Perthes, nekrosis avaskular, rehabilitasi komprehensif.

scholarly journals MRI-semiotics of the gluteal muscles in patients with avascular necrosis of the femoral head and Legg-Calve-Perthes disease

2019 ◽  
Vol 25 (4) ◽  
pp. 481-486
Author(s):  
G.V. Diachkova ◽  
◽  
M.P. Teplenky ◽  
K.A. Diachkov ◽  
T.A. Larionova ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Perthes Disease

scholarly journals Reconstructive Restorative Surgical Interventions in Complex Treatment of Children with Legg-Calve-Perthes Disease

2012 ◽  
Vol 19 (4) ◽  
pp. 47-54
Author(s):  
D. B Barsukov
Keyword(s):  
Femoral Head ◽  
Corrective Osteotomy ◽  
Pelvic Osteotomy ◽  
Perthes Disease ◽  
Treatment Results ◽  
Anatomic Structure ◽  
Surgical Interventions ◽  
Deformity Progression ◽  
Bone Coverage

For optimization of anatomic and functional treatment results pre- and postoperative roentgenologic data were analyzed for 120 patients aged from 6 to 14 years with Legg-Calve-Perthes disease accompanied by severe affection of epiphysis. Mean follow up period after reconstructive (remodeling) surgical interventions, i.e. corrective osteotomy of the femur, pelvic osteotomy by Salter, combinations of those 2 techniques, triple pelvic osteotomy made up 10 years. It was shown that remodeling of femoral head was possible only when the degree of bone coverage was equal or exceeded 1. If that parameter was below 1 the conditions for deformity progression developed. Roentgenologic variants of the affected joint anatomic structure that enabled to define concretely the indications to a certain type of femoral head surgical remodeling were determined.

scholarly journals Surgical Treatments for Legg-Calvé-Perthes Disease: Comprehensive Review

10.2196/27075 ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. e27075
Author(s):  
Arash Maleki ◽  
Seyyed Mohammad Qoreishy ◽  
Mohammad Nabi Bahrami
Keyword(s):  
Femoral Head ◽  
English Language ◽  
Surgical Techniques ◽  
Public Health Problem ◽  
Perthes Disease ◽  
Comprehensive Review ◽  
Varus Osteotomy ◽  
Manual Search ◽  
Surgical Methods ◽  
Innominate Osteotomy

Background Legg-Calvé-Perthes disease (LCPD) is a common public health problem that usually occurs between the ages of 4 and 8 years, but it can occur between the ages of 2 and 15 years. This condition occurs due to the interruption of blood supply to the femoral head. Up to now, different surgical and nonsurgical treatments, including femoral varus osteotomy, innominate osteotomy, pelvic osteotomies, triple osteotomy, Chiari osteotomy, and shelf acetabuloplasty, have been suggested for noncontainable LCPD hips. Objective The aim of this comprehensive review was to investigate the various surgical techniques used for LCPD. Methods An advanced electronic search of the English-language literature was performed from October 8 to 14, 2020. The electronic databases PubMed, MEDLINE, Web of Science, Embase, Ovid, and Google scholar were searched using appropriate search terms. A manual search of references also was performed. After retrieving the studies, duplicates were removed, and the remining studies were screened based on the title, abstract, and full text. The quality of the selected articles was assessed, and the required data were extracted from eligible articles. Results A total of 22 studies were included in the review. Based on the results of the reviewed studies, there are three main factors that influence the treatment outcomes in patients with Perthes disease. These factors are onset age, femoral head involvement severity, and treatment method. The disease has a poor prognosis in children over 8 years old, but this group of patients can also benefit from advanced surgical methods. In patients aged less than 6 years, the disease has a generally good prognosis, but in those aged between 6 and 8 years, its prognosis is variable. Thus, the need for surgical intervention requires close observation of signs. Once any head signs are observed, dynamic arthrography is beneficial before choosing the treatment approach. Conclusions This review provides clinicians with a brief guideline for the treatment of patients with LCPD.

scholarly journals A Newly Modified Salter Osteotomy Technique for Treatment of Developmental Dysplasia of Hip That Is Associated with Decrease in Pressure on Femoral Head and Triradiate Cartilage

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Seyed Mokhtar Esmaeilnejad-Ganji ◽  
Seyed Mohammad Reza Esmaeilnejad-Ganji ◽  
Mohammad Zamani ◽  
Hesam Alitaleshi
Keyword(s):  
Femoral Head ◽  
Developmental Dysplasia ◽  
Developmental Dysplasia Of Hip ◽  
Center Edge ◽  
Salter Osteotomy ◽  
Innominate Osteotomy ◽  
Femoral Shortening ◽  
Osteotomy Technique ◽  
The Mean

Background and Purpose. The Salter innominate osteotomy has been an effective method to treat the developmental dysplasia of hip (DDH) over the past decades; however, several postoperative complications and deficiencies were reported. In this study, we evaluated outcome of a newly modified Salter osteotomy in patients presenting with DDH. Methods. We reviewed retrospectively 76 patients (90 hips) with DDH aged ≥ 18 months, who underwent open reduction and a modified osteotomy by a single surgeon. The distal osteotomy segment of pelvis was shifted anterolaterally in the amount of osteotomy cross-section, but not downwards. The mean age at surgery was 2 years and 11 months (1.5 to 16 years). Femoral shortening was conducted when necessary. The duration of operation varied between 60 and 90 minutes. The mean follow-up was 4 years and one month (range 15 months to 7 years and 9 months). All patients were followed up both clinically (based on the modified MacKay criteria) and radiologically (based on the modified Severin criteria). Results. Clinically, 94.5% of hips had excellent and good results at final follow-up, and only 5.5% had a fair condition. Radiographically, at the final follow-up 77.8% of hips were grade IA (excellent), 12.2% were grade IB, 6.7% were grade II, and 3.3% were grade III (fair). The preoperative mean acetabular index was 47.85° (41° to 59), which decreased to 17.16° (13° to 22°) immediately after the surgery (p<0.0001) and progressed to 11.24° (7° to 19°) at the final follow-up (p<0.0001). The mean initial postoperative center-edge angle was 30.3° (25° to 42°) significantly improved to 39.1 (31° to 56°) at the final follow-up (p<0.0001). Avascular necrosis of femoral head occurred in 4.4% of hips (4 patients). Conclusion. The results show that our modified Salter osteotomy is safe and associated with significant benefit for the management of patients suffering from DDH.

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