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[Osteochondritis dissecans of the hip in Legg-Perthes-Calve disease]
Insights
Osteochondritis dissecans can complicate Perthes' disease, particularly in older males. Diagnosis involves femoral head irregularities, with avascular fragments visible on imaging, guiding treatment from conservative measures to surgery.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Radiology
Background:
- Osteochondritis dissecans (OCD) is a joint condition that affects bone and cartilage.
- Perthes' disease is a childhood hip disorder affecting the femoral head.
- OCD can occur as a complication of Perthes' disease, though rarely.
Purpose of the Study:
- To review the literature on Osteochondritis dissecans complicating Perthes' disease.
- To present the authors' experience with this rare condition.
- To describe diagnostic criteria and treatment recommendations.
Main Methods:
- Literature review of 27 published cases.
- Analysis of 6 personally observed cases.
- Radiographic and arthrographic evaluation.
Main Results:
- The condition was observed in older male patients compared to typical Perthes' disease.
- Diagnosis relies on persistent femoral head irregularity and abnormal texture.
- Avascular fragments are visible on radiographs and arthrography.
- Clinical signs are often subtle unless a loose body causes locking.
Conclusions:
- Osteochondritis dissecans complicating Perthes' disease is a rare condition predominantly affecting older males.
- Early diagnosis through imaging is crucial.
- Treatment varies from conservative management for moderate disability to surgical removal of loose bodies to prevent arthrosis.
Abstract:
Osteochondritis dissecans in a few cases may complicate Perthes' disease. A review of the literature shows 27 published cases. The authors have personally observed 6 cases. The age of the patient was older than in most Perthes' disease. All were male. This condition is diagnosed by the presence of a persisting irregularity of the femoral head with abnormal texture. The clinical signs are not obvious except in cases of recurrent locking where there is a loose body. The avascular fragment is visible on standard radiographs and is best recognised by arthrography. Conservative treatment should be given when the disability is moderate. The loose body should be removed surgically when it is mobile, when it bulges into the joint space or when there are signs of early arthrosis.