A. Nordwig, H. Hetschko (Halle)  

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6 Years  

Male  

Leg-Bones  

metabolic  

6 year old male, intermittend pain in the right hip for 8 months, occasional limping; Physical therapy for 3 months.
Examination of the right hip presented the following results:
- shortened leg
- palpatory pain in the groin and trochanter major
- Drehmann-sign positive
- extension / flexion: 0 / 10 / 120
- abduction / adduction: 25 / 0 / 30
- outer rotation / inward rotation: 20 / 0 / 20  

The causes for aseptic bone necrosis of the femoral head are not known. In children, the most common illness is Perthes-Calves disease. Of the spontaneous necroses, mostly children between teh age of 3 and 7 years are afflicted, boys more often than girls. Familial occurance has been noted. Perthes-Calves disease is also seen in combination with the hip dysplasia as early as in the 2nd year of life. Here, the causes can be many: vacular damage and epiphyseal damage through repositional trauma.

The most commonly used staging criteria:
a.) Joint space increased
b.) Epiphysis increased in density and flattened.
c.) Fragmentation
d.) Newly formed bone.

The grade of affliction was categorized by Cattarall:
I) ventral area of the epiphysis, no sequesters
II) half of the epiphysis is afflicted, seqester seen, small metaphyseal lesions
III) 3/4 of the epiphysis is afflicted, large sequester seen, diffuse metaphyseal lesions
IV) Complete epiphysis is sequestered, dramatic affliction of the metaphyseal region.  

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<- view Ultrasound 1

Ultrasound 1: Hip sonography, ventral. Irregular contours, right femoral head with irregular echo pattern with areas of high echogenicity and low echogenicity. Femoral head is altogether lower in height. Epiphyseal gap is fuzzy with increased echogenicity. Slight joint effusion to the right.

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<- view Ultrasound 2

Ultrasound 2: Hip sonography, ventral. Right and left sides for comparison.

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<- view X-Ray 1

X-ray 1: Enlargened right joint space. Flattened, increased density in the head, somewhat fragmented. The femoral neck is "chunky" and widened (Image and diagnosis from the Insitute for Radiology, City Hospital Martha-Maria in Halle-Dölau)


 

Imaging including endoscopy  

Particularly at the beginning of the illness, arthritis of various origin; i.e. Coxitis fugax as well as enchondral dysostosis.  

Possibility of a periodic illness over many years.  

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Legg-Calve-Perthes disease, juvenile Osteochondronecrosis, Head of the Femur, Hip, femur head, Perthes disease, AVN, avascular necrosis, aseptic bone necrosis, limping, hip pain, knee pain, arthritis, child, childhood, pediatric radiology  

A Nordwig, H Hetschko. Perthes disease (Necrosis of the femoral head). PedRad [serial online] vol 3, no. 8.
URL: www.PedRad.info/?search=20030819114534