• Begins with presence of subchondral lucent line (cresent sign) • Femoral head appears to fragment or dissolve • Result of revascularization process with bone resorption producing collapse with subsequent patchy density and lucencies
• Hip related symptoms are most prevalent • Lateral pillar classification based on this stage • Can last from 6m to 2y
• involvement of the anterior epiphysis only
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Technique guide are not considered high yield topics for orthopaedic standardized exams including the ABOS, EBOT and RC.
A six-year-old boy presents with left leg pain and limping. Radiographs are shown in Figures A and B. The radiographic changes necessary for accurate lateral pillar classification of his disease are usually evident how long after the onset of symptoms?
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For children with Legg-Calve-Perthes(LCP) disease, all of the following factors are associated with femoral head incongruity and worse clinical outcome EXCEPT:
Maintenance of less than 50% of lateral pillar height
Presentation at 5 years of age
Lateral subluxation of the femoral head
Calcification lateral to the epiphysis
Presence of a radiolucency in the shape of a V in the lateral portion of the epiphysis (Gage sign)
A 9-year-old male is brought in for initial evaluation of persistent painless limping favoring the left leg. His symptoms began 6 months ago, and have been progressively worsening. He has nearly full abduction. Radiographs and an MRI are shown in Figures A, B, and C. What is the next most appropriate step in treatment?
Left hip aspiration and culture under fluoroscopic guidance
Continued activity limitation and bracing
Femoral or pelvic osteotomy
Core decompression of the femoral head
Work-up for underlying metabolic bone disease
HPI - Limping of 5 days duration.
How would you manage this patient?
HPI - Patient presents with limping of 2 years duration with intermittent right knee, hip, groin and thigh pain.
What is the likely diagnosis?
HPI - Patient started experiencing mild pain two years back.Later started Limping.Now pain has reduced in intensity.
What stage do you think it is using the Waldenstrom's classification system?