• 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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Figure 36 shows the radiograph of a 14-year-old boy who has been treated in the past for Perthes’ disease with an abduction brace. He now has hip pain that limits his activity, and nonsteroidal anti-inflammatory drugs have failed to provide relief. What is the most appropriate treatment?
Proximal femoral varus osteotomy
Salter innominate osteotomy
Distal transfer of the greater trochanter
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Figure 26 shows the radiograph of an otherwise healthy Caucasian 5-year-old boy who has a painless limp. What is the best treatment option?
Varus derotation osteotomy
Physical therapy and range-of-motion exercises
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
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?
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)