Diferencia entre revisiones de «Legg-Calve-Perthes disease»

Revisión actual - 22:09 23 ago 2019

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 Features

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 with rest
Decreased hip abduction and internal rotation

Differential Diagnosis

Pediatric limp

Hip Related

Other Causes of Limping

Developmental dysplasia
Fracture
- Toddler's fracture
- Tillaux fracture, adolescent
Neoplasm:
- Leukemia
- Ewings
- Osteogenic sarcoma
- Metastatic neuroblastoma
Osteomyelitis
Myositis
Other:

Evaluation

Plain radiographs of the hip
- May be normal early in disease
- If high suspicion obtain bone scan or MRI
Imaging findings:
- Widening of cartilage space of affected hip
- Small size ossific nucleus of femoral head
- Subchondral stress fracture line in femoral head

Management

Orthopedic surgery consultation
Non-weight bearing
Protection of hip joint (maintain in abduction and internal rotation)

Disposition

Generally may be discharged
- Should be done in consultation with orthopedic surgery to ensure appropriate therapy and close follow-up

References

Authors:

@@ Línea 1: / Línea 1: @@
 ==Background==
+*[[Avascular necrosis of hip|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 Features==
+*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 with rest
+*Decreased hip abduction and internal rotation
-- ischemic necrosis of femoral head
+==Differential Diagnosis==
+{{Pediatric hip DDX}}
-- exact mech unknown
+==Evaluation==
+[[File:Roe-perthes.jpg|thumb|]]
+*Plain radiographs of the hip
+**May be normal early in disease
+**If high suspicion obtain bone scan or MRI
+*Imaging findings:
+**Widening of cartilage space of affected hip
+**Small size ossific nucleus of femoral head
+**Subchondral stress fracture line in femoral head
-- more common in boys
+==Management==
+*Orthopedic surgery consultation
+*Non-weight bearing
+*Protection of hip joint (maintain in abduction and internal rotation)
-- 10% of cases occur bilaterally
+==Disposition==
+*Generally may be discharged
-- inc 1 per 1200 - 12,000
+**Should be done in consultation with orthopedic surgery to ensure appropriate therapy and close follow-up
-==Diagnosis==
-Age - 4 to 9 yrs
-Present - Painless Limp
-Labs - normal
-Xrays - Compression, collapse, frag-
-mentation
-Presentation
-- classically a painless limp
-- may have mild, intermittent pain in hip, groi, thigh or knee
-- pain often activiity related & relieveed by rest.
-Physical Exam
-- decr range of motion, esp internal rotation and abduction.
-- may have leg length discrepancy Xrays
-- initially show increase in articular space or compression of bone
-- as necrosis progresses, epiphysis will collapse and fragment
-==Treatment==
-- "Containment" by external orthoses, for up to 18 mo or surgery
-- 50% of untreated get disabling arthritis
-- younger diagnosed, better prog
 ==See Also==
+*[[Pediatric hip pain]]
+==References==
+<references/>
-Peds:  Hip Pain
+[[Category:Pediatrics]]
+[[Category:Orthopedics]]
-[[Category:Peds]]