scholarly journals OPTIMIZATION OF DIAGNOSIS OF EARLY STAGES OF LEGG-CALVE-PERTHES DISEASE IN CHILDREN

2020 ◽  
Vol 8 (4) ◽  
pp. 574-581
Author(s):  
T.I. Menshchikova ◽  
◽  
S.N. Luneva ◽  
Е.L. Matveeva ◽  
A.G. Gasanova ◽  
...  
Keyword(s):  
Femoral Head ◽  
External Rotation ◽  
Organic Matrix ◽  
Pathological Process ◽  
Chloride Ions ◽  
Perthes Disease ◽  
Ultra Sound ◽  
Healthy Children ◽  
Serum Total Calcium ◽  
Subchondral Plate

Aim. Optimization of the diagnosis of the initial stages of Legg-Calve-Perthes disease in children of 4-7 years old using biochemical and ultrasound methods. Materials and Methods. Patients aged 4-9 years (15 boys, 10 girls) complaining of morning pain in walking, contracture in the hip joint, lameness, were examined. The duration of the disease ranged from several days to 2-3 months. The control was a group of healthy children aged 4-9 years (n=22, 12 boys, 10 girls). Ultrasound of the hip joints was performed on Hitachi scanner (Japan) using a linear sensor with 7.5 MHz frequency. In the blood serum of patients, the follow-ing markers of resorption of the organic matrix of bone tissue were determined: the amount of sulfate sulfur, hexuronic acids (HAC), hexoses, hexosamines, sialic acids with calculation of their ratios: hexoses/hexuronic acids, hexoses/sulfate, sulfate/hexuronic acids, hexuronic ac-ids/hexosamines. Besides, concentration of electrolytes was determined in serum: total calcium and chloride ions and inorganic phosphate. On the basis of these fata, the system index of elec-trolytes SIE=ССа.CCl/CPO4 was calculated. The concentrations of parameters obtained in the ex-amination of 25 healthy children of 4 to 7 years of age were taken for norm. Results. In children with duration of the disease from several days to several weeks, an ultra-sound scan along the neck of the femur revealed thickening of the joint capsule to 0.73 (0.7:0.77) mm. With the progression of the pathological process, separate lumpy formations were visualized in the region of the subchondral plate of the femoral head in the position of abduction of the limb and internal/external rotation, which indicated the appearance of initial destructive changes in the region of the subchondral plate of the femoral head. Using biochemical methods, besides increase in the concentration of organic matrix degradation markers, there were also determined increase in the extent of sulphatation of the organic matrix and insignificant alterations of the content of separate electrolytes. Conclusions. The use of biochemical and ultrasound research methods allows optimization of the diagnosis of the initial stages of Legg-Calve-Perthes disease.

Neutrophil to Lymphocyte Ratio May be a Predictive Marker of Poor Prognosis in Legg-Calvé-Perthes Disease

2016 ◽  
Vol 26 (6) ◽  
pp. 598-601 ◽  
Author(s):  
Burak Kaymaz ◽  
Kadir Büyükdogan ◽  
Nazan Kaymaz ◽  
Erkam Kömürcü ◽  
Umut Hatay Golge ◽  
...  
Keyword(s):  
Femoral Head ◽  
Poor Prognosis ◽  
Predictive Ability ◽  
Predictive Marker ◽  
Perthes Disease ◽  
Healthy Children ◽  
Mean Values ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Background Legg-Calvé-Perthes disease (LCPD) is the idiopathic avascular necrosis of the femoral head in childhood. The pathologic changes seen in the femoral head are likely a result of vascular factors. Blood neutrophil to lymphocyte (N/L) ratio is a simple marker of subclinical inflammation. This study aims to to analyse the predictive ability of N/L ratio for the prognosis in LCPD patients. Methods Patients who had been diagnosed as LCPD from 2008 to 2014 were investigated retrospectively and 40 LCPD patients (33 male and 7 female) and 25 healthy age and sex-matched children (controls) were included in the study. LCPD patients were divided into 2 groups according to expected prognosis (good prognosis expected Herring A and B patients as Group I and poor prognosis expected Herring B-C and C patients as Group II) and healthy children (control) were included in Group III. All the patients’ hematological markers were analysed. Results Mean age was 7.1 ± 2.0 years in group I (4.9-12 years), 8.3 ± 2.2 years (4-12.5 years) in group II and 7.8 ± 1.3 years (6-12 years) in group III. Mean values for Groups I, II and III for neutrophil to lymphocyte (N/L) ratio were 1.13 ± 0.65, 1.75 ± 0.95, 1.08 ± 0.37, respectively. The mean neutrophil to lymphocyte (N/L) ratio of Group II was higher than the other 2 groups (p = 0.003). Conclusions N/L ratio may give us information about the natural course of LCPD and may be used as independent predictor of prognosis in patients with LCPD.

The modified Stulberg classification is a strong predictor of the radiological outcome 20 years after the diagnosis of Perthes’ disease

2021 ◽  
Vol 103-B (12) ◽  
pp. 1815-1820
Author(s):  
Stefan Huhnstock ◽  
Ola Wiig ◽  
Else Merckoll ◽  
Svein Svenningsen ◽  
Terje Terjesen
Keyword(s):  
Femoral Head ◽  
Skeletal Maturity ◽  
Strong Predictor ◽  
Perthes Disease ◽  
Radiological Outcome ◽  
Long Term Follow Up ◽  
The Mean ◽  
Stulberg Classification

Aims The aim of this study was to assess the prognostic value of the modified three-group Stulberg classification, which is based on the sphericity of the femoral head, in patients with Perthes’ disease. Methods A total of 88 patients were followed from the time of diagnosis until a mean follow-up of 21 years. Anteroposterior pelvic and frog-leg lateral radiographs were obtained at diagnosis and at follow-up of one, five, and 21 years. At the five- and 21-year follow-up, the femoral heads were classified using a modified three-group Stulberg classification (round, ovoid, or flat femoral head). Further radiological endpoints at long-term follow-up were osteoarthritis (OA) of the hip and the requirement for total hip arthroplasty (THA). Results There were 71 males (81%) and 17 females. A total of 13 patients had bilateral Perthes’ disease; thus 101 hips were analyzed. At five-year follow-up, 37 hips were round, 38 ovoid, and 26 flat. At that time, 66 hips (65%) were healed and 91 (90%) were skeletally immature. At long-term follow-up, when the mean age of the patients was 28 years (24 to 34), 20 hips had an unsatisfactory outcome (seven had OA and 13 had required THA). There was a strongly significant association between the modified Stulberg classification applied atfive-year follow-up and an unsatisfactory outcome at long-term follow-up (p < 0.001). Between the five- and 21-year follow-up, 67 hips (76%) stayed in their respective modified Stulberg group, indicating a strongly significant association between the Stulberg classifications at these follow-ups (p < 0.001). Conclusion The modified Stulberg classification is a strong predictor of long-term radiological outcome in patients with Perthes’ disease. It can be applied at the healing stage, which is usually reached five years after the diagnosis is made and before skeletal maturity. Cite this article: Bone Joint J 2021;103-B(12):1815–1820.

Legg-Calvé-Perthes Disease

1986 ◽  
Vol 7 (10) ◽  
pp. 299-304
Author(s):  
William P. Bunnell
Keyword(s):  
Birth Weight ◽  
Femoral Head ◽  
Vascular Supply ◽  
Skeletal Age ◽  
Perthes Disease ◽  
Unknown Etiology ◽  
Necrotic Bone

Perthes disease is a condition of unknown etiology in which the vascular supply of the developing femoral head is temporarily interrupted, causing necrosis and collapse of the bony femoral head, followed by spontaneous revascularization and healing of the necrotic bone. It was independently described by four different authors (Legg, Calvé, Perthes, and Waldenstrom) in 1909 and 1910. They identified the condition as an affliction of the hip distinct from trauma and infection. The term "coxa plana" was applied to the characteristic flattening of the femoral head seen in Perthes disease. It was not until 10 years later that the actual pathology of avascular necrotic bone was described. EPIDEMIOLOGY The condition has its onset in children ranging in age from 2 to 12 years, with the majority of patients presenting between the ages of 4 and 8 years. Boys are affected four times more frequently than girls, and the condition is bilateral in approximately 15% of affected children. Certain constitutional factors are frequently found in children with Perthes disease. Skeletal age is delayed in nearly 90% of children affected with it. Affected boys have been found to be an average of 1 in shorter and affected girls 3 in shorter in height than their unaffected peers. Birth weight of affected children is frequently lower than average.

scholarly journals Algorithm for Early Diagnosis and Treatment Tactics of Diseases Accompanied by Coxalgia in Children

2009 ◽  
Vol 16 (2) ◽  
pp. 67-71
Author(s):  
Il'ya L'vovich Lobov ◽  
S E Kul'banskaya ◽  
M A Uronova ◽  
I L Lobov ◽  
S E Kulbanskaya ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Femoral Head ◽  
Early Diagnosis ◽  
Hip Joint ◽  
Blood Circulation ◽  
Perthes Disease ◽  
Diagnosis And Treatment ◽  
Joint Diseases

Examination and treatment of 524 children with coxalgia has been performed. Algorithm for early diagnosis of various hip joint diseases accompanied by coxalgia has been elaborated. The factors causing hip joint response resulting in different pathology including Leg-Calve-Perthes disease have been determined. In the majority of cases application of modified splint in combination with drug therapy enabled to normalize blood circulation in the affected joint and prevent the development of secondary deformities of the femoral head.

scholarly journals EVALUATION OF THE RANGE OF MOTION OF A HIP ARTHROPLASTY SYSTEM: A COMPUTER SIMULATION STUDY

2021 ◽  
Vol 29 (5) ◽  
pp. 246-248
Author(s):  
GUILHERME GUADAGNINI FALOTICO ◽  
VALÉRIA ROMERO ◽  
RICARDO BASILE ◽  
EDMILSON TAKEHIRO TAKATA
Keyword(s):  
Femoral Head ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
External Rotation ◽  
Angular Displacement ◽  
Computational Method ◽  
Technical Standards ◽  
Level Of Evidence ◽  
Mean Values

ABSTRACT Objective: To date, the literature lacks consensus on the most efficient method to measure the range of motion of an in vitro prosthetic system. In this study, we propose the use of a relatively low-cost online software to measure the range of motion of hip prosthetic implants manufactured in Brazil and compare its results with the current technical standards for hip arthroplasty. Methods: Three different diameters of femoral heads were evaluated (28 mm, 32 mm, and 36 mm). The mean values of the angular displacement of the prosthesis in each motion axis were obtained by computer simulations. Results: The range of motion with each femoral head was 28mm (extension/flexion: 148°, internal/external rotation: 179°, adduction/abduction: 107°), 32 mm (152°/185°/114°), and 36 mm (158°/193°/120°). Conclusion: The computational method showed that the larger the femoral head, the greater the range of motion of the hip joint prosthetic system. Additional clinical studies are necessary to compare the physical results obtained with the values found in this study by computational modeling. Level of evidence V, Experimental study.

Relationship of peroxidation indicators and hemograms in children with hip joint pathology

2021 ◽  
Vol 66 (2) ◽  
pp. 104-109
Author(s):  
M. P. Teplen’kiy ◽  
E. L. Matveeva ◽  
E. S. Spirkina ◽  
A. G. Gasanova
Keyword(s):  
Lipid Peroxidation ◽  
Femoral Head ◽  
Hip Joint ◽  
Hip Dysplasia ◽  
Stage Ii ◽  
Perthes Disease ◽  
Antioxidant Protection ◽  
Aseptic Necrosis ◽  
Joint Pathology ◽  
Group I

The increase in the number of patients with hip pathologies among children of different ages makes the diagnosis and treatment of these diseases one of the most actually existing problems in modern orthopedics. The aim of the work was to determine the features of the lipid peroxidation system - antioxidant protection and hemogram indices in children with various forms of hip joint pathology. The results of a preoperative examination of 47 patients aged 6-15 years (average age 10.3 years) who were treated at the clinic “FSBI NICC“ TO ”named after academician G. A. Ilizarova, Ministry of Health of the Russian Federation. There were 25 boys and 20 girls. Given nosology, patients were divided into five groups. The diagnosis was established on the basis of a clinical and radiological examination. Group I consisted of 8 male patients with stage II Perthes disease (mean age 8.75 + 1.63). Group II includes 16 patients (8 boys, 7 girls) with stage III Perthes disease. (average age 11.80 + 0.89). Group III included 12 patients (6 boys, 6 girls) with aseptic necrosis of the femoral head (average age 14.7 + 2.35). Group IV consisted of 4 patients (1 boy, 3 girls) with epiphyseal dysplasia. (average age 10.25 + 1.36). Group V includes 7 patients with hip dysplasia complicated by aseptic necrosis of the femoral head (mean age 8.33 + 2.11). The norm is the data that was obtained after examining 10 healthy male adolescents (age 13-14) and 5 female adolescents (age 8-14 years). Changes in lipid peroxidation rates and antioxidant activity are unidirectional in different forms of pathology of the hip joints in children, and the content of peroxidation products reliably correlates with hemogram values in stage II osteochondropathy and complicated hip dysplasia. In the complex of diagnostic measures for children with dystrophic lesions of the hip joint, to clarify the nature and stage of the pathological process, as additional criteria, hemogram indicators and lipid peroxidation systems - antioxidant protection can be used.

Mutation of COL2A1 in a Chinese Family with Presentations of Legg-Calvé-Perthes Disease

2020 ◽  
Author(s):  
denglu yan ◽  
zhaojie Wang ◽  
Zhi Zhang
Keyword(s):  
Femoral Head ◽  
Sanger Sequencing ◽  
Structural Changes ◽  
Genetic Factors ◽  
Mutation Detection ◽  
Perthes Disease ◽  
Chinese Family ◽  
Col2a1 Gene ◽  
Whole Exome ◽  
Missense Substitution

Abstract Background: The aim of this study was to identify genetic factors and chromosomal regions contributing to osteonecrosis of the femoral head (ONFH) in a Chinese family with presentations of Legg-Calvé-Perthes Disease (LCDP). Methods: In this study, we performed whole exon sequencing of a Chinese family with LCPD for mutation detection. Ten members had ONFH in twenty-seven family members in four generations family, 5 unaffected members of the studied family and 5 normal peoples as control were underwent whole exome sequencing for mutation detection. Structural modeling test was applied to analyze the potential structural changes caused by the missense substitution. Results: In this Chinese family affected by LCPD, the mutation (c.3508 G>A, p. Gly1170Ser) in exon 50 of COL2A1 in the Gly–X–Y domain was present in 10 patients but absent in 5 unaffected members of the studied family and in 5 control chromosomes from unaffected individuals of matched geographical ancestry. The COL2A1 gene mutation was further validated by Sanger sequencing, confirmed that were heterozygous for the mutation. Then, we identified the p.Gly1170Ser mutation in exon 50 of COL2A1 in a Chinese family with LCPD. Conclusions: This study maps the mutation of mutation (c.3508 G>A, p. Gly1170Ser) in exon 50 of COL2A1 in the Gly–X–Y domain in a Chinese family of LCPD, which causes osteonecrosis of femoral head.

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