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Perthes Disease (Avascular Necrosis)

Pediatric Orthopedic

InShort


Perthes Disease, more correctly named Legg Calve Perthes disease (LCPD) is a form of avascular necrosis of the capital femoral epiphysis in skeletally immature individuals.


The disease can cause significant damage to the hip joint and can result in permanent disability.


Treatment of LCPD is complex depending upon the extent of the disease, age of the child, presence of epiphyseal collapse. It is recommended children with LCPD be referred to a competent pediatric orthopaedic surgeon. Treatment may involve physical therapy, casting, braces, and surgery.


Plain radographs are sufficient to establish the diagnosis. MRI may be somewhat helpful to predict the extent of the disease. Protein S & C should be evaluated if LCPD is bilateral.


The age of onset may be as young as 18 months, or as old as 9 years. The disease process usually runs a course of 2 years. In general the younger the child at the age on onset the better the prognosis. The earliest symptoms are a reduction of abduction of the affectd hip. Restricted internal rotation and a painless limp are often seen in LCPD. Radiographs may demonstrate widening of the joint space with or without the classic crescent subchondral fracture of the epiphysis early in the process.


Children with bilateral LCPD should have blood work to evaluate levels of Protien S and Protein C that regulate coagulation. These children may be predisposed to early myocardial infarction.


 

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