Fact-sheet: Legg-Calvé-Perthes disease
Updated on 10/02/2020 at 4:51 PM
View all RADEOS cases associated with this fact-sheet
Definition
Idiopathic ischemic necrosis of the femoral head ossification center
Clinical features
- Predominates between 4 and 8 years of age, in boys
- Painful limp
- Afebrile
- Limited range of motion in abduction and internal rotation
Laboratory findings
No inflammatory syndrome
Radiography
0-2 months: Normal radiographs
2-4 to 6-8 months: Subchondral fracture
- Subchondral fracture: subchondral lucent line with sclerosis of the epiphyseal ossification center
- Crescent sign of the epiphyseal ossification center
6-8 to 12 months: Fragmentation phase
- Fragmented appearance of the epiphyseal ossification center
- Flattening, dense, and mild sclerosis of the epiphyseal ossification center
> 12 months: Reossification phase
- Metaphyseal remodeling with widened, irregular physis
- Possible reconstruction ad integrum
MRI
Dynamic gadolinium injection to assess viability of the lateral column (prognosis)
Diffusion: comparison of affected versus normal Hip, poor prognosis if ADC > 1.6
Classification
Catterall classification (AP and lateral radiographs):
- 1: Small area of necrosis of the anterolateral portion of the epiphyseal nucleus
- 2: Necrosis of the anterior half of the epiphyseal nucleus
- 3: Involvement of nearly the entire nucleus
- 4: Involvement of the entire nucleus
Herring classification (AP radiograph):
- A: Lateral pillar preserved
- B: Lateral pillar height decreased by less than 50%
- C: Lateral pillar height decreased by more than 50%
