Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg...
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Transcript of Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg...
![Page 1: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/1.jpg)
Legg-Calvé-Perthes Disease
by John A. Herring, Hui Taek Kim, and Richard Browne
J Bone Joint Surg AmVolume 86(10):2103-2120
October 1, 2004
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 2: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/2.jpg)
An example of a hip in group A of the lateral pillar classification in a patient who was 9.7 years old at presentation.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 3: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/3.jpg)
An example of a hip in the B/C border group of the lateral pillar classification in a patient who was 7.1 years old at presentation.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 4: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/4.jpg)
An example of a hip in group C of the lateral pillar classification in a patient who was 8.3 years old at presentation.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 5: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/5.jpg)
An example of a hip in group B of the lateral pillar classification in a patient who was 7.4 years old at presentation.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 6: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/6.jpg)
An example of a hip in the B/C border group of the lateral pillar classification in a patient who was 8.5 years old at presentation.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 7: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/7.jpg)
An example of a hip in the B/C border group of the lateral pillar classification in a patient who was 8.1 years old at presentation.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 8: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/8.jpg)
An example of a class-I hip according to the Stulberg classification in a patient who was 9.8 years old at presentation, when the hip was categorized as group B according to the lateral pillar
classification.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 9: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/9.jpg)
Frog-leg lateral radiograph, made at the age of seventeen years, showing no differences between the two hips.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 10: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/10.jpg)
An example of a class-II hip according to the Stulberg classification in a patient who was 8.8 years old at presentation, when the hip was categorized as group B according to the lateral pillar
classification.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 11: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/11.jpg)
Frog-leg lateral radiograph, made at the age of 17.0 years, showing a round femoral head on the right, which is slightly larger than the left femoral head.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 12: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/12.jpg)
A method for distinguishing between Stulberg class-II and III hips.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 13: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/13.jpg)
A perpendicular is erected at the center of the line.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 14: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/14.jpg)
A best-fit circle is drawn to match the surface of the femoral head.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 15: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/15.jpg)
With use of the same radius, a best-fit circle is drawn over the surface of the femoral head on the frog-leg lateral radiograph.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 16: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/16.jpg)
In this example, the circle fails to fall within 2 mm of the surface of the femoral head on the frog-leg lateral radiograph.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 17: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/17.jpg)
An example of a class-III hip according to the Stulberg classification.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 18: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/18.jpg)
Frog-leg lateral radiograph, made at the age of sixteen years and seven months, showing an ovoid femoral head.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 19: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/19.jpg)
An example of a class-IV hip according to the Stulberg classification.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 20: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/20.jpg)
Frog-leg lateral radiograph, made at the age of fifteen years and three months, showing more severe flattening of the femoral head.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 21: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/21.jpg)
Another class-IV hip according to the Stulberg classification.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 22: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/22.jpg)
Frog-leg lateral radiograph, made at the age of seventeen years and four months, showing severe flattening of both femoral heads.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 23: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/23.jpg)
A class-V hip according to the Stulberg classification.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.
![Page 24: Legg-Calvé-Perthes Disease by John A. Herring, Hui Taek Kim, and Richard Browne J Bone Joint Surg Am Volume 86(10):2103-2120 October 1, 2004 ©2004 by The.](https://reader036.fdocuments.net/reader036/viewer/2022062407/56649d125503460f949e6479/html5/thumbnails/24.jpg)
Frog-leg lateral radiograph, made at the age of thirteen years and three months, showing marked subluxation and incongruity between the femoral head and the acetabulum.
John A. Herring et al. J Bone Joint Surg Am 2004;86:2103-2120
©2004 by The Journal of Bone and Joint Surgery, Inc.