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Tuesday, 10 May 2011


Legg-Calvé-Perthes disease:

- is idiopathic avascular necrosis (AVN) of the growing femoral epiphysis seen in children, and should not be confused with the Perthes lesion of the shoulder.

- ages of 4 - 8 years, and the most frequent presenting feature is pain with or without a limp. In 10 - 12 % of cases both hips are involved.

Plain film

Early signs
  • asymmetrical femoral epiphyseal size (smaller on affected side)
  • apparent increased density of the femoral head epiphysis
  • widening of the medial joint space
  • blurring of the physeal plate (stage 1: see staging of Legg-Calve-Perthes syndrome)
  • radiolucency of the proximal metaphysis
Late signs

Eventually, the femoral head begins to fragment (stage 2), with subchondral lucency (crescent sign) and redistribution of weight-bearing stresses leading to thickening of some trabeculae which become more prominent.

The typical findings of advanced burnt out (stage 4) Perthes disease are:

  • femoral head deformity with widening and flattening
  • proximal femoral neck deformity

Additionally, tongues of cartilage sometimes extend inferolaterally into the the femoral neck, creating lucencies, which must be distinguished from infection or neoplastic lesions. The presence of metaphyseal involvement no only increases the likelihood of femoral neck deformity, but also make early physeal closure with result leg length disparity more likely.

(Source :

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