Legg-Clave-Perthes disease

Legg-Clave-Perthes disease is the name given to idiopathic osteonecrosis of femoral head epiphysis by compromising the supply of blood in this area. The disease occurs in children between 4-10 years. It insidious onset and can occur after a hip injury. In most cases the disease is unilateral. Both hips are involved in more than 10% of cases, and the joints are affected sequentially not simultaneously.
Although the etiology is unclear and have found several risk factors in children: sex, socioeconomic group and the presence of an inguinal hernia and genitourinary tract abnormalities. More specifically boys are affected 3-5 times more often than girls, and the incidence increases in humble socio-economic groups and children with low birth weight.
The disease is degenerative and causes loss of bone mass increase of the hip joint collapse and deformation of femoral head and acetabular surface it contains. It is characterized by idiopathic avascular osteonecrosis of the femoral head epiphysis. The disease include coxa plana, osteochondritis and joint destruction.
Common symptoms include hip pain, thigh and knee exacerbated by leg movement. The apparent adoption of a position and limit movement analgesics balance. Appears groin muscle atrophy and limb length inequality. In some cases, physical activity cause severe irritation or inflammation of the affected area.
Orthopedic treatment is crucial. It helps prevent degenerative osteoarthritis. Attempts to remove pressure on the joint until the lesions heal. The practice of physiotherapy, and surgery tijarea.Treatment includes immobilization of the thigh. Sometimes it is necessary to partial immobilization with bed rest or immobilization up to 12-18 months in traction, belts, gypsum. These treatments maintain the foot in external rotation.
Physical therapy is important to prevent contractures and muscle atrophy. Swimming is recommended because it allows working with low pressure thigh muscles. You should avoid using steroids and alcohol because they reduce blood oxygenation.Diagnosis of the condition should be placed as soon as possible, patients presenting after the age of 8 years shows a negative prognosis. The prognosis is more negative for girls than for boys, they usually presented a more severe disease.
Pathogenesis and causes
Femoral epiphysis is always involved. In 20% of cases patients have bilateral damage to the femoral bone. The cause is unknown, but affected children shows delayed bone development, growth and disproportionate short stature. The disease can be idiopathic or may result from slipping femoral epiphysis, trauma, steroid administration, crisis siclemiei, sinovitei toxic or congenital dislocation of the hip.
The etiology of Legg-Clave-Perthes disease remains unclear.It is suspected these pathogenetic theories:Blood-supply of the femoral head epiphysis is interruptedBone infarction-occurring especially subchondral cortical bone, while the articular cartilage continues to growRevascularization and new-appearing ossification-Disease is present when there is a subchondral fracture with normal physical activity and not traumaticEpiphyseal growth-plate changes occur secondary subchondral fracture.
Pathophysiology of the condition:Rapid growth occurs in relation to the supply of blood to the development of secondary centers of epiphyses osficicare forcing an interruption of blood flow and adequate predispunindaceste avascular necrosis areas. Interrupting the supply of blood to bone necrosis cause, removing necrotic tissue and replacing it with new tissue.Reinlocuirea bone can be complete and perfect, that you can derive new bone healthy and anatomically normal. Adequate bone replacement depends on patient age, associated with this infection, damage to joint and simultaneous mechanical and physiological factors. Necrosis may occur after trauma or infection, but idiopathic lesions may develop during the period of rapid growth epiphyses.
Signs and symptoms
The disease is mostly seen in patients 3-12 years old with an average age of 7 years. Boys are affected three times more often than girls. Symptoms are usually present for several weeks because the child does not experience pain. The earliest signs of Legg-Calve-Perthes disease is a flaccid member intermittently, especially after exercise, mild or intermittent pain in the anetrioara balance. Legg-Clave-Perthes disease is the most common cause of flaccid member in children 4-10 years and is described as painless. The most common sign is pain perisistenta.
Thigh pain may develop and is the result of the affected bone necrosis. This pain may include the medial side ipsilateral knee or groin. Quadriceps muscles and adjacent soft tissue may undergo atrophy and hip flexion contracture may develop adductie. Pain is present in passive internal rotation movements of the thigh.
Clinical signs and symptoms include the following:-Thigh or groin pain, slight pain in kneeLimp-leg, no history of traumaEspecially motion-limiting internal rotation and abductionPainful in the leg-supportingMuscle atrophy secondary-not used-Muscle spasmLower-limb inequality due to collapseAtrophy of the thigh-groin smaller circumference than healthy limb-Short stature.Rotation test with the patient-physician rotates thigh supinatie effective external and internal defense tesutl demonstrates spasm and especially internal rotation.
Disease progression:
Short-term evolution of the disease is associated with the deformation of the femoral head at the completion stage of healing. Risk factors include advanced age, clinical onset, extensive damage of the femoral head, femoral head retention, reducing the movement of the hip and premature closure of growth plate.Long-term evolution of the disease is associated with hip osteoarthritis has potential as an adult. In patients with defective metaphyses, those in whom the disease develops in childhood and those who have advanced disease of the femoral head with the more complex the prognosis is severe residual deformity and degenerative arthritis occurs in 100% of cases.