5 EpidemiologyOne in 1200 children younger than 15 years is affected by LCPDMales are affected 4-5 times more often than femalesLCPD most commonly is seen in persons aged 4-8 (2-12) years, with a average age of 7 yearsBilateral involvment %DDH – 25%
6 PathologyThe blood supply to the capital femoral epiphysis is interrupted (arteries and veins).Bone infarction occurs, especially in the subchondral cortical bone, while articular cartilage continues to grow. (Articular cartilage grows because its nutrients come from the synovial fluid.)Revascularization occurs, and new bone ossification starts.Changes to the epiphyseal growth plate occur secondary to the subchondral fracture.
7 Symptoms Painless limp Hip or groin pain, which may be referred to the thighMild or intermittent pain in anterior thigh or kneeUsually no history of trauma
8 SymptomsDecreased range of motion (ROM), particularly with internal rotation and abductionPainful gaitAtrophy of thigh muscles secondary to disuseMuscle spasm- mild hip contracture of degrees may be present
9 Symptoms Leg length inequality due to collapse Thigh atrophy: Thigh circumference on the involved side will be smaller than on the unaffected side secondary to disuse (Trendelenburg sign)
15 Reossification- healing New bone formation- the bone density returns
16 Residual stage Reossified femoral head Remodeling of the head shape Remodeling of the acetabulum
17 Catterall classification Stage 1:Antero-medial portion of head involved and no collapse, metaphyseal changes do not occur and the epiphyseal plate is not involvedHeal without significant sequelaeStage 2:More head involved and may - fragmentation of the involved segmentThe involved segment shows increased density and uninvolved pillars of normal bone prevent significant collapse - regeneration without much loss of height and the end result is usually good. Metaphyseal reaction localised
18 Catterall classification Stage 3:More of the head involved - collapse as uninvolved pillars not large enough t prevent collapseMay show head within a headThe metaphysis is usually diffusely involved - broad neck and the epiphyseal plate is unprotected and also usually involved - results poorerStage 4:Whole head involvement and severe collapse occurs early and restoration of the femoral head usually less completeThe metaphyseal changes may be extensiveThe epiphyseal plate is often involved - abnormal growth (coxa magna, coxa breva, coxa vara and coxa valga)
19 Herring classification Lateral pillar clasificationDetrmine treatment and prognosis
20 Salter - Thompson Classification Stage A: - Lateral portion of femoral capital epiphysis present - less than 50% head involvedStage B: - Lateral portion of femoral capital epiphysis absent - more than 50% head involved (Lateral margin of epiphysis protects epiphysis from stress)
22 Mose methodIf head conforms to a single ring in both X- Ray planes - good prognosisIf head varies from perfect circle by no more than 2mm - fair resultsIf head varies by more than 2mm in any plane - poor results
30 Goal of treatmentPreservation of the roundness of the femoral head and prevention of deformity while the condition runs its course.
31 Conservative treatment Relieve weight bearingAchieve and maintain ROMContainment of the femoral epiphysis within the confines of the acetabulum (Petrie-style casts, Atlanta /Scottish Rite/ brace, Toronto brace and other orthotic devices)