Lessons learned in the management of Legg-Calvé-Perthes disease

In the assessment of Legg-Calvé-Perthes disease, true lateral radiographs of the femoral head are required. Lack of head sphericity does not preclude good range of motion, which may mislead one into expecting a favorable outcome in very young patients; nor does head flattening prevent successful surgical containment and restoration of sphericity in some older children. Slings and springs, broomstick casts, soft tissue releases, and day or night bracing all have a place in obtaining and retaining a good range of abduction. If orthotic management is to be employed, it must be consistently effective throughout all everyday circumstances. Surgical containment procedures may shorten the clinical course of the disease. If innominate osteotomy is to be performed, there must be a near-normal range of hip motion, whereas femoral osteotomy does not have this prerequisite. Successful containment may be achieved by extension derotation femoral osteotomy, thereby avoiding the undesirable persistent deformity that may follow varus osteotomy. The cooperation of the family in management programs is important and greatly depends upon parental understanding. This understanding is enhanced by presenting parents with an explanatory booklet, written in everyday language, and by leisurely consultations.