Legg-Calve-Perthes Disease Case Study

The radiograph depicts Legg-Calvé-Perthes disease (LCPD) of the left hip. The right hip is not affected. This childhood hip disorder is a result of idiopathic avascular necrosis of the growing bony epiphysis of the femoral head, with boys affected four times more that girls (Texas Scottish Rite Hospital for Children, n.d.). This interruption in blood supply to the bone results in necrosis, and the femoral head become flattened due to weight and pressure placed on the bone during normal physical activity (Texas Scottish Rite Hospital for Children, n.d.).

View: This is an Anterioposterior view demonstrating the entire pelvis, sacrum, the lumbosacral articulation, both proximal femurs and hip joints.

Pathologies seen in the radiograph: There is decreased bone density in the left femoral head, neck, and in the region of the greater trochanter. The left femoral head has flattened and widened with a shortening of the femoral neck. There appears to be two fractures lines in the femoral neck, possibly stress fractures indicated by the increase radiodensity. Additionally, the left acetabulum appears to be compromised lacking its typical round concave appearance. These pathological findings are suggestive of Legg-Calve-Perthes disease.

Given this child’s age and greater than 50% of the femoral head is involved as determined by the radiograph, his outcome is poor and treatment is more similar to adult femoral head osteonecrosis (Texas Scottish Rite Hospital for Children, n.d.). Surgical treatment options for his age may include femoral and pelvic osteotomies; however a perfusion MRI should be performed to assess the extent of femoral head involvement (Texas Scottish Rite Hospital for Children,