Perthes Disease

Duhring s disease Legg-Calve-Perthes disease 207... 

Wingstrand H (1999) Significance of synovitis in Legg-Calve-Perthes disease. J Pediatr Orthop B 8 156-160... 

A normal hip shows a concentric reduction of the femoral head in the acetabulum - the joint space is equidistant all around the hip. The tear-drop represents the medial wall of the acetabulum. The distance from the tear-drop to the femoral head maybe compared with the contralateral side. On a perfectly positioned film, an increase in this distance is abnormal and may represent a hip effusion, infolded labrum after dislocation or intra-articular loose body entrapment after dislocation. Fibrofatty tissue within the joint (acetabulum pulvinar), septic arthritis and Perthes disease may also give similar findings. 

In one study, 64% of limping children with no history of gait dysfunction or trauma had primary involvement of the hip joint. Most cases were caused by transient synovitis and resolved with rest Many children with hip-related gait dysfunction have had a recent upper respiratory tract infection. Other causes Include osteitis, rheumatic fever, rheumatoid arthritis, and Perthes disease. 

Perthes disease, also known as Legg-Calv -Perthes syndrome after the investigators who independently identified this condition in 1910, is related to an idiopathic avascular necrosis of the proximal femoral epiphysis. It mainly affects children 3-12 years old with a peak incidence at approximately 4-8 years and a definite prevalence (4 1) in males and lower social classes (Guille et al. 1998). The onset of Perthes disease is related to the development of the femoral head vasculature, which includes the ascending cervical arteries (branches from the medial and lateral circumflex arteries), the lateral epiphyseal vessels and... 

The affected children limp and complain of pain over the hip, groin or inner thigh made worse by activity. Internal rotation and abduction of the hip may be limited. From the histopathologic point of view, the course of Perthes disease includes four successive stages I, ischemia and necrosis II, fragmentation and resorption III, reossification and resolution IV, remodeling. 

Ekinci S, Karnak I, Tanyel FC (2004) Infantile fibromatosis of the sternocleidomastoid muscle mimicking muscular torticollis. J Pediatr Surg 39 1424-1425 El-Miedany YM, Housny IH, Mansour HM et al (2001) Ultrasound versus MRI in the evaluation of juvenile idiopathic arthritis of the knee. Joint Bone Spine 68 222-230 Erken EH, Katz K (1990) Irritable hip and Perthes disease. J Pediatr Orthop 10 322-326... 

Orthop Clin North Am 37 133-140 Futami T, Kasahara Y, Suzuki S et al (1991) Ultrasonography in transient synovitis and early Perthes disease. J Bone Joint Surg Br 73 635-639... 

Robben SGF, Meradjl M, Diepstraten AFM (1998) US of the painful hip in childhood diagnostic value of cartilage thickening and muscle atrophy in the detection of Perthes disease. Radiology 20835-42... 

Wirth T, LeQuesne GW, Paterson DC (1992) Ultrasonography in Legg-Calvd-Perthes disease. Pediatr Radiol... 

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