ENFERMEDAD DE LEGG-CALVE- PERTHES Y DESLIZADA LA EPÍFISIS CAPITAL FEMORAL: PRINCIPALES CAUSAS DEL DESARROLLO. La enfermedad de Legg-Calvé-Perthes u osteocondritis deformante juvenil consiste en una necrosis aséptica de la cabeza del fémur de los niños debida a una. La enfermedad de Legg-Calve-Perthes (LCPD) es una rara enfermedad de la cadera. Ésta afecta a niños de 2 a 12 años de edad. La LCPD es un trastorno de .
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It should not be confused with Perthes lesion of the shoulder. Perthes disease is relatively uncommon and in Western populations has an incidence approaching 5 to Boys are five times more likely to be affected than girls.
Presentation is typically at a younger age than slipped upper femoral epiphysis with peak presentation at years, but confidence intervals are as wide as years 8. Most children present with atraumatic hip pain or limp 3,5,6. Some children have a coincidental history of trauma. This may precipitate the presentation or the realisation of symptoms that in fact had been long standing. nkos
Blood tests are typically normal in Perthes. It is important to be certain that there is no other cause of osteonecrosis e. Osteonecrosis generally occurs secondary to abnormal or damaged blood supply to the femoral epiphysis, leading to fragmentation, bone loss, and eventual structural collapse of the femoral head.
The best initial test for the diagnosis of Perthes is a pelvic perthfs.
In a small number of patients with Perthes, the radiograph will be normal and persistent symptoms will trigger further imaging, e. The investigation of atraumatic letg will often include a hip ultrasound to look for effusion, but ultrasound is unlikely to pick up osteonecrosis. The radiographic findings are those of osteonecrosis. There is a separate system for staging of Perthes disease see Catterall classification. The radiographic changes to the femoral epiphyses depend on the severity of osteonecrosis and the amount of time that there has enfermeead alteration of blood supply:.
As changes progress, the width of the femoral neck increases coxa magna in order to increase weight-bearing support. Eventually, the femoral head begins to fragment stage 2with subchondral lucency crescent sign and redistribution of weight-bearing stresses leading to thickening of xalve trabeculae which become more prominent.
The typical findings of advanced burnt out stage 4 Perthes disease are:. Additionally, tongues of cartilage sometimes extend inferolaterally into the femoral neck, creating lucencies, which must be distinguished from infection or neoplastic lesions 4.
The presence of metaphyseal involvement not only increases the likelihood of femoral neck deformity but niow make early physeal closure with resulting leg length disparity more likely. Traditionally arthrography performed under lsgg anesthesia with conventional fluoroscopy is performed to assess congruency between the femoral head and the acetabulum in a variety of positions 3.
Hip arthrodiastasis in Legg-Calvé-Perthes disease.
MRI is increasingly replacing this, in an effort to eliminate pelvic irradiation. Treatment in Perthes disease is largely related to symptom control, particularly in the early phase of the disease.
As the disease progresses, fragmentation and destruction of the femoral head occurs.
In this situation, operative management is sometimes required to either ensure appropriate coverage of the femoral head by the acetabulum, or to replace the femoral head in adult life.
The younger the age at the time of presentation, the more benign disease course is expected and also for same age, the prognosis is better in boys than girls due to less maturity 5,8. Prognosis is also influenced by the percentage of femoral head involvement and degree of primary deformity of the femoral head and the secondary osteoarthritic changes that ensue.
The aim of therapy is to try and maintain good femoroacetabular contact and a round femoral head. Bracing may be used in calce cases, although femoral neck and acetabular osteotomies may be required to correct more severe abnormal femoroacetabular malalignment. You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.
Enfermedad de Legg-Calve-Perthes | Patient Handouts | 5MinuteConsult
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