🦴 Section 719.3 · Legg-Calvé-Perthes Disease (LCPD)

Nelson Textbook of Pediatrics 22nd Edition | Legg-Calvé-Perthes disease: idiopathic avascular necrosis of the femoral head in children. Age 4-8 years, male predominance 4:1, bilateral in 10%. Presents with painless limp, limited hip abduction/internal rotation. Herring lateral pillar classification (Groups A, B, B/C border, C) predicts outcome. Principle of treatment: containment — keep femoral head within acetabulum during reossification. Options: observation/bracing for mild cases (age <6, group A), femoral varus osteotomy or pelvic osteotomy for group B/C or older children.

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📋 30 Clinical Scenarios — Legg-Calvé-Perthes Disease

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🩺 Clinical Recognition: Legg-Calvé-Perthes Disease

Select a presentation to review diagnostic clues and management per Nelson 719.3.

📋 Stepwise Management of LCPD

🔑 Key Principles — Nelson Section 719.3
• Definition: Idiopathic avascular necrosis of femoral head. Four stages: initial (necrosis) → fragmentation (collapse) → reossification (healing) → residual (remodeling).
• Epidemiology: Age 4-8 years, male:female 4:1, bilateral 10%.
• Presentation: Painless limp, activity-related groin/thigh/knee pain, limited hip abduction and internal rotation.
• Imaging: Radiographs (AP, frog-leg) show sclerosis, fragmentation, collapse. MRI early diagnosis, arthrography for containment.
• Classification: Herring lateral pillar (Groups A, B, B/C, C) — most prognostic.
• Treatment principle: Containment. Age <6 and Group A → observation/PT. Age >6 or Group B/C → surgical containment (varus osteotomy or pelvic osteotomy).

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Legg-Calvé-Perthes Disease (Nelson 719.3)