Legg–calvé–perthes Disease

Legg–calvé–perthes Disease is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Idiopathic avascular necrosis of the femoral head in children
  • Genetics:
    • Increased frequency with factor V Leiden and anticardiolipin antibodies

Pediatric Considerations
Exclusively a pediatric disease

Etiology

  • Successive vascular occlusions causing characteristic findings
  • Growing evidence implicating hypercoagulable states
  • May be multifactorial
  • Risk factors include tobacco smoke, wood smoke, low birth weight, birth length <50 cm
  • Progression through 4 stages of disease:
    • Initial stage: Dense femoral head causing intermittent synovitis
    • Fragmentation: Femoral head becomes soft and deforms causing loss of motion
    • Healing: New bone grows into femoral head
    • Residual: Healed femoral head with some deformity
  • More common in boys: Male > female, 4:1
  • More common among Caucasians
  • Most commonly occurs between ages of 3 and 7:
    • Range 18 mo–18 yr
  • Bilateral in 10–15% of cases
  • Associated with short stature, deprived populations, delayed & disproportionate growth

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