Perthes

Question 1

poor Prognostic variables for LCP:

Answer 1

• asphericity of the femoral head and congruency at maturity
• age >6 years at presentation
• decreased hip ROM/adduction contracture
• obesity
• longer duration of the healing cycle

Question 2

Waldenstrom’s 4 stages

Answer 2

Initial - infarction, radiographically occult

Fragmentation - dissolving femoral head 2/2 revasc process (most symptomatic)

Reossification- necrotic bone resorbed by creeping substitution (can last 18mo)

Healing/Remodeling - remodeling until skeletal maturity

Question 3

Lateral Pillar (Herring) Classification

Answer 3

determine at beginning of fragmentation stage

A: full height, good outcomes

B: >50% height, poor outcome if >6yo

B/C: ~50% height

C: <50% height, poor outcomes in all

Question 4

Stulberg Classification

Answer 4

rating residual femoral head deformity and joint congruence

Normal, Ovoid, Flat
Staged I-V

Question 5

Earliest radiographic finding of LCP?

Answer 5

medial joint space widening (during the initial stage)

Question 6

Indications for Non-Op Treatment

Answer 6

children <8 years
lateral pillar A

bracing/casting have no role

60% of patients do not require surgery

Question 7

Operative indications

Answer 7

> 8 years of age
Lateral pillar B and B/C
- femoral varus osteotomy
- pelvic osteotomy