LEGG-CALVE-PERTHES SYNDROME

1
1909
LEGG-CALVE-PERTHES SYNDROME
1910
Waldenstrom
Definition
2
Etiology
Trauma
1950s
Congenital
CDH
3
Cytotoxic agents
Extracapsular arterial ring
Growth related systemic abnormalities
Ascending cervical vessels Retinacular brunches
Transient synovitis
1-3
The artery of the ligamentum teres
Vascular embarassment
3
Lig Tres
Lat.Epiphysial Ar.
Ant. Retinacular Ar.
Post.Sup.Ret.Ar.
Intracapsular ring
Inf. Metaphysial Ar.
Sup. Metaphysial Ar.
Post.Inf.Ret.Ar.
Subsynovial arterial ring
Ant. Ascending brunch
Med. Ascending Br.
Lat ascending brunch
Post.ascendig Br.
Extra capsular ring
Medial femoral circumflex
Lateral femoral circumflex
Sup.Inf. Gluteal Ar.
4
Circulation of the femoral head
6 Mo
4Yr.
7 Yr.
5
Physical examination
Abduction
R.O.M
Deformity
Synovitis
Limited
Medial rotation
Trendelenburg test
Atrophy
Long standing
Thigh
Calf
Buttock
!!!
Head collapse
Limb length inequaliy
R/O
Lab.Test
6
Stage I a Part or whole of the epiphysis is
sclerotic with no collapse
7
Stage I b Sclerosis Collapse
Herring
8
Herring Lat. Pillar classification
9
Stage II a Early fragmentation One or two
vertical fissure
10
Crecent sign
Salter extent
11
Stage II b Advanced fragmentation
12
Stage III a Early new bone formation Voven
bone less than 1/3
13
Stage III b New bone more than 1/3 with normal
texture
14
Management
Deformity
DJD
Growth disturbance
Not later than fragmentation phase
Each patient must be assessed
Clinically Radiologically
A.P Frog leg Lat.
Loss of motion
Joint contracture
Stage
The extent of involvement
Pain
At risk signs
15
Treatment is not indicated if
No at risk signs
Catterall Group 1,2 Salter Thompson Type A
Herring Type A
Already in the reossification stage
16
Calcification lat. To the epiphysis
Large
Gage
1
2
or
Ex. Metaphysial changes
Lat. displacement
Surgery
Deformity
Horizontal growth plate
Head at risk signs Catterall 1971
17
Clinical risk signs
Age
5 6 8 yr.
Duration
4 36 Mo
Motion Contractures
Sex
18
N.C.H
Scotish-Rite
Simple Abd.
Trilateral
19
Scotish Wright
20
Elizabeth Town
21
Shelf
22
Varus osteotomy
23
Varus derotational osteotomy
24
Hinge abduction
Valgus osteotomy
25
Cheilectomy
26
Chiari
ChiariShelf
27
Trochantric advancement
28
Trocantric advancement
29
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