Legg Calves Perthes (LCP) and Slipped Capital Femoral Epiphysis for USMLE
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- čas přidán 26. 07. 2024
- Pathologies related to the femoral head are Legg-Calves Perthes and Slipped Capital Femoral Epiphysis
Leg-calve-Perthes is more common in the 4-10 year olds. Less than 4 years old is dysplastic hip dysplasia.
PATHOGENESIS
The blood supply from the neck goes upwards and from the acetabulum goes downwards in legg-calves-perthes. When the plate growth is greater than the blood supply there will be necrosis of the epiphysis a nd the epiphysis will die. When the epiphysis regenerates it regenerates as bone and then there is leg-length discrepancy.
In slipped catpial femoral epiphysis. is more common in the 10-18 year old age. The femoral head slips downwards at the epiphyseal plate. Usually displacing medially and posterior, not anteriorly.
Causes of leg-Calve Perthes is usually idiopathic. Any condition that compromises the blood supply can also cause it. Trauma, steroid use which increase the coagulopathy of the blood vessels. Sickle Cell Anemia. Finally congenital dislocation of the hip compromises blood supply to the hip leading to leg-calve-perthes.
For slipped capital femoral ephiphysis the most common cause is obesity. Also be caused by the epiphyseal plate growing too quickly to support the weight of the body such as in a thin tall patient. Equally common in females and males, however, slightly more in males. But in leg-calve-perthes it is more common in male than it in females. There are some endocrine causes of Slipped Capital Femoral Epiphysis such as hypothyroid, hypogonadism and Growth Hormone decificiency and these endocrine causes are usually bilateral. The other risk factor is radiation such as cancer in the abdominal or hip region. Also renal failure can lead to this.
Clinically leg-Calve-Perthes presents as a painless intermittent limp, but after time it becomes painful with activity. However in the Slipped Capital Femoral Epiphysis starts off with pain that is dul aching from the groin all the way to the knee and increases with physical activity. There is decrease range of motion and the foot can't rotate internally, not abduction/flesion and the elg rolls externally when laying down. Both conditions has Trendelenburg gait is positive. Normally hips are flat, but when there is a tendelenurg gait the hip goes towards to normal side secondary to weakness of the gluteal muscle.
On X-Ray Leg-Calve-Perthes shows widening of the joint space between the hip and the femoral head. Also the bone density tends to decrease over time, due to disuse. With slipped capital femoral epiphysis there is a stage system of mild moderate and severe. in mild there are different staging depending on AP and lateral x-ray. MRI helps diagnose sites of avascular necrosis
Treatment for Leg-Calve-Perthes is to initially decrease weight bearing with the help of crutches, abduction arthrosis equipment which seperates the femur and hip which gives time for the hip and femur to heal and prevents degeneration of the femoral head. Surgery for Leg-Calve-Perthes is indicated if there is a large area of necrosis and if the conservative measures are not working. In slipped Capital femoral Epiphysis you would want an orthopedic consult. There are more severe complications that lead to avascular necrosis and chondrolysis. Femoroacetebelar impingement is when the femoral head goes into the neck leading to impingement of the femoral head.
Great video. This is how medicine should be taught, because this is how we have to practice! I mean, get two diseases that are on the same differential because their clinical symptoms are similar, and then explain how they are different, and thus how you distinguish one from another. Thank you
My son (6 1/4) is just through it. We were lucky to have the right diagnosis (Perthes Catterall IV i.e. 100% of femoral head destroyed) at the very beginning when he was 3 1/2. On the day of diagnosis we cut kindergarten time from 100% to 50%, told our employer we can only work 70% each and started therapy: Every day physiotherapy, traction, cycling and almost every day swimming. Kiga only in wheelchair, daily steps from 30.000 down to max 3.000. Result: a perfect 1 of 10.000 reconstruction of femoral head. No pain after first 3 months of disease, full flexibility in every direction, perfectly centralized head. There is no difference to his other leg observable at all.
We can highly recommend to be extremely consequent, follow a progressive approach with a lot of activity and movement - !!! but with eliminating pressure on the joint!!! E.g. cycling only while sitting in the saddle and with very high cadence. Very important is to care for the psych as well - we told him a wheelchair is not a stigma - but a sports-tool for building up muscles and having fun.
I had Perthes as a child,I remember having to do the cast twice.The hardest part for me was being in traction for several times.And being in a car there were no mini vans back then, eventually I healed up great,I started paying football not long after the doctors gave me the green light.I road a skateboard for many years.I hope your loved one has a great recovery.
I am resident orthopaedic surgeon, joined very recently this field. The video, although introductory was a tremendous help in making concepts. God Bless you.
Waqar Hassan
Please contact me back wambalob@gmail.com
I have perthes disease
Waqar Hassan plz send contact no,I am from india
@@wambalowong5375 plz give me your contact no,I am from India
literally saved my life with this video... Thanks!
Thank you for the video,I am affected by this condition since I was 5.It just came out of suddenly without warnings.I used to always run everywhere as a kid.Life is interesting.Love yourself.
Very informative! I had Perthes that went undiagnosed until i was in my mid twenties and at first was misdiagnosed.
Did you ever get it treated I am currently 22yrs old and I just got diagnosed 2 years ago but I can bearly walk now and I am scared . If you could please let me know how your situation went thanks.
Thank you a million for this amazing astonishing explanation , u make it very simple and easy and
Absolutely save my time
Excellent video! THANK YOU!
Very good explanations & visuals. Than!
That was easily understood , thank you 😊
I have LCP since I was 11 in 1984 . Had to wear a cowboy brace(very embarrassing especially when you’re 11 to 12 years old) then I was in traction for about nine months when I was 13.. I was told not to do any prolong running standing walking until I got my hip replaced later in life in my 30s.. i’m now 48 still super active although I do live my life in pain my right leg is about an inch and a half shorter very limited range of motion.. I’m looking to seek for hip replacement soon and it’s to the moon baby
An excellent upload
Thank you so much
Very helpful ♥️
Thank you so much the differential diagnosis for this was difficult for me to understand
+TheKoukiMonster Your welcome. I am glad you benefited
Great video
very easy to follow. Great job
Glad you think so!
Nice video mate. Can you tell me what software u used to publish this video. Thanks!
Hi I really enjoyed the video very informative I had SCFE on both both hips in 1975 three pins were fixed and each side and I basically had very few problems until the last few years when I had to endure quite a bit of a pain in the left hip as arthritis had set in, as predicted by my original surgeon.. I recently had a hip replacement on that side and the surgeon commented on some difficulty working around the original three screws to remove the head. My observation is that in all my research (thank you Internet) on this condition is that no mention is ever made of the stopping of growth and by this I mean specifically puberty. I can only mention that this was quite a psychologically painful for me at the time as I was 15 when I had the operations and obviously being behind others in my age group and growth, it was a real challenge for the typical teenager that counters this abnormality. I withdrew from sports and any activity That might of exposed my lack of pubic development.
I wonder why it’s not included in discussions?
I should mention that following the operations, normal pubic development and growth spurt occurred within the next 12-24 months. (From 5ft 6in to 6ft 3in).
@@TexAraujo Lucky for you! My growth spurt never came. Just shy of 6ft
@@TexAraujo Lucky for you! My growth spurt never came. Just shy of 6ft
Thanks sir
Welcome
I had this when I was a kid and had pins inserted. My question, as an adult can this give u arthritis?
great video this is exactly what I had when I was 4 years old. it was a Severe case and had to have big surgery to pin the hip back into place. both me and my older brother had the same thing the hospital said it was very rare for that to happen. i was left with one leg Alot shorter and smaller than the other. i had another surgery to try to fix the growth problem. in my good leg (RIGHT LEG) they put 4 screws and 2 plates in the knee to slow the growth so the other leg could catch up. it worked good but i had the pins taken out a little early because i broke one of the screw and i think that was giving me pain. I am 20 years old now and am fit and strong but my legs still are not even but are very good compared to the difference before. I have one question at the moment i am working and my job requires me to stand in the same spot for long periods of time basically all day. on concrete floors i cant stand evenly and get a lot of pain in my neck and feet my good leg is taking all the weight. could this cause big problems for me in the future? Thanks for the video
Very interesting story, I am glad it all worked out. Uneven legs can start causing hip problems I would recommend seeing a physiotherapist, they will be able to recommend something. If you stand like that for too long often times your can mess up your hip or the knee so it is important you see one soon.
thank you so much ...
Good
What does any of this have to do with my Ruger 380?
nice
+muzammil firoze Thanks
what xrays do you order to confirm scfl
nicely explained
No one gives a damn about answering questions about adults who never knew they had Perthes and who are now severely arthritic and deformed. The average ortho just barely knows about it. Do we suffering adults not matter?
What about intentional harming?
Sir is there any solution for this disease
My kid has this problem and I'm desperate, needs help!
Talk to ur doctor
Can u help me my son is having most of those problems and I do t know what to do anymore
If u wanna contact my email is rozlynegitt@gmail.com
@@rg.9238 give me your what's app no,I am from India
@@yuvrajhaque8023 +919895696595 please help
Uh see tuh bell um 😂
Thanks for the video. I supposed that you'r medic because of the handwriting.
Wish I had this video fourteen years ago, when the books did such a horrible job explaining these.
I have perthes
Please send your contact no(what's app no) I am from india
Great video
Dr Mohammed zafari plz send your contact no,I am from India