Legg-Calve-Perthes disease: Difference between revisions
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*Bilateral in 10% | *Bilateral in 10% | ||
===Clinical Presentation=== | ===Clinical Presentation=== | ||
*Insidious onset of mild hip pain and limp | *Insidious onset of mild hip pain and limp | ||
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*Pain often exacerbated by activity, relieved w/ rest | *Pain often exacerbated by activity, relieved w/ rest | ||
*Decreased hip abduction and internal rotation | *Decreased hip abduction and internal rotation | ||
==Differential Diagnosis== | |||
{{Pediatric hip DDX}} | |||
==Diagnosis== | |||
===Imaging=== | ===Imaging=== | ||
*Initial radiographs may be normal | *Initial radiographs may be normal | ||
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**Small size ossific nucleus of femoral head | **Small size ossific nucleus of femoral head | ||
**Subchondral stress fracture line in femoral head | **Subchondral stress fracture line in femoral head | ||
==Treatment== | ==Treatment== | ||
Revision as of 06:24, 1 May 2015
Background
- Avascular necrosis of femoral head
- Capital femoral epiphysis fails to grow because of lack of blood supply
- Affects children 4-9yr old
- Male:female 4:1
- Bilateral in 10%
Clinical Presentation
- Insidious onset of mild hip pain and limp
- May have painless limp
- May have referred pain to groin, thigh, knee
- Pain often exacerbated by activity, relieved w/ rest
- Decreased hip abduction and internal rotation
Differential Diagnosis
Pediatric hip pain
- Acute rheumatic fever
- Developmental dysplasia of hip
- Femur fracture
- Juvenile idiopathic arthritis
- Legg-Calve-Perthes disease
- Septic arthritis of the hip (peds)
- Lyme disease arthritis
- Slipped capital femoral epiphysis
- Transient (toxic) synovitis
- Osteosarcoma
Diagnosis
Imaging
- Initial radiographs may be normal
- If high suspicion obtain bone scan or MRI
- Findings
- Widening of cartilage space of affected hip
- Small size ossific nucleus of femoral head
- Subchondral stress fracture line in femoral head
Treatment
- Non-weight bearing
- Referral to ortho
See Also
Source
Tintinalli