Post on 07-May-2015
transcript
Osteonecrosis
Avascular Necrosis of Hip&
Perthe’s Disease
Anatomy
Applied Anatomy
Causes
Pathogenesis
Pathology
Imaging
Sites..
Staging
Management
OSTEOCHONDROSIS (OSTEOCHONDRITIS)
Differential Diagnosis
AVN Hip
Anatomy
Retinacular Vessels
Clinical Features
• Pain
• Movement restriction
– Abduction
– Internal Rotation
X-Ray
Post Traumatic
MRI
Osteo Arthritis
STAGING
Core Decompression
Unloading Osteotomy
Arthroplasty
PERTHES’ DISEASE
• Perthes’ disease – or rather Legg–
Calvé–Perthes disease.
• 1910-the condition was described
independently by three different
people
• is a painful disorder of childhood
characterized by avascular
necrosis of the femoral head
Progression
Clinical Features
• Pain
• Movement restriction– Abduction– Internal Rotation
• Limp
Herring’s Lateral Pillar Classification
Catterall’s Classification
Head at Risk Signs
GUIDELINES TO TREATMENT
• based on an assessment of
– the stage of the disease,
– the prognostic x-ray classifications,
– the age of the patient
– The clinical features, particularly range of
abduction and extension.
Children under 6 years
• No specific form of treatment has much
influence on the outcome.
• Symptomatic treatment, including activity
modification, is appropriate.
Children aged 6–8 years
• In this group the bone age is more important than the chronological age
Bone age at or below 6 years
• Lateral pillar group A and B (or Catterall stage I and II) – symptomatic treatment.
• Lateral pillar group C (or Catterall stage III and IV) – abduction brace.
Bone age over 6 years
• Lateral pillar group A and B (Catterall stage I and II)
– abduction brace or osteotomy.
• Lateral pillar group C (Catterall stage III and IV)
–outcome probably unaffected by treatment, but some would operate.
Children 9 years and older
• Except in very mild cases (which is rare), operative
containment is the treatment of choice.
Aim of Treatment
CONTAINMENT
Abduction Splint
Innominate osteotomy
Femoral Osteotomy
Innominate Osteotomy
Combined
Thank You