Enfermedad de Legg-Calvé-Perthes
Summary
Definition
History and exam
Key diagnostic factors
- presencia de factores de riesgo
- cojera
- rango de movimiento limitado en la articulación de la cadera
Other diagnostic factors
- estatura baja
- pérdida de masa muscular
- hiperactividad
- signo de Trendelenburg
- sinovitis
- dolor en la rodilla
- dolor en el muslo
- dolor en la ingle o los glúteos
- longitud asimétrica de las extremidades
- traumatismo menor
Risk factors
- sexo masculino
- 4 a 8 años de edad
- origen socioeconómico bajo
- estados de hipercoagulabilidad
- población urbana
- raza y latitud norte
- sinovitis de cadera transitoria
- derrame articular de la cadera
- tabaquismo pasivo
- displasias esqueléticas
- anomalías congénitas
- trisomía 21
- trastornos de la conducta
- endocrinopatía
Diagnostic tests
1st tests to order
- radiografías bilaterales de cadera
Tests to consider
- hemograma completo (HC)
- velocidad de sedimentación globular en suero
- proteína C-reactiva sérica
- gammagrafía ósea
- resonancia magnética (IRM) de las caderas
Treatment algorithm
con dolor agudo
menores de 5 años de edad
de 5 a 7 años de edad
mayores de 7 hasta 12 años de edad
mayores de 12 años de edad
Contributors
Authors
Andrew Wainwright, FRCS (Tr & Orth) Med
Consultant Orthopaedic Surgeon
Nuffield Orthopaedic Centre
Oxford
UK
Disclosures
AW declares that he has no competing interests.
Dominique Knight, BSc, MBBS, FRCS
Consultant Paediatric Orthopaedic Surgeon
Bristol Royal Children’s Hospital
Bristol
UK
Disclosures
DK declares that she has no competing interests.
Acknowledgements
Dr Andrew Wainwright and Dr Dominique Knight would like to acknowledge Dr Jwalant S. Mehta and Dr Sandeep Hemmadi, who wrote the original topic and whose work is largely reflected in the current version. JSM and SH declared that they had no competing interests.
Peer reviewers
Phillip Thomas, FRCS (Orth)
Consultant Orthopaedic and Paediatric Orthopaedic Surgeon
Llandough Hospital
Vale of Glamorgan
UK
Disclosures
PT declares that he has no competing interests.
Young-Jo Kim, MD, PhD
Associate Professor of Orthopaedic Surgery
Children's Hospital
Boston
MA
Disclosures
Not declared.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981 Sep;63(7):1095-108. Abstract
Catterall A. The natural history of Perthes' disease. J Bone Joint Surg Br. 1971 Feb;53(1):37-53. Abstract
Salter RB, Thompson GH. Legg-Calvé-Perthes disease. The prognostic significance of the subchondral fracture and a two-group classification of the femoral head involvement. J Bone Joint Surg Am. 1984 Apr;66(4):479-89. Abstract
Herring JA, Neustadt JB, Williams JJ, et al. The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop. 1992 Mar-Apr;12(2):143-50. Abstract
Canale ST, D'Anca AF, Cotler JM, et al. Innominate osteotomy in Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1972 Jan;54(1):25-40. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Artritis séptica
- Sinovitis transitoria de la cadera
- Anemia falciforme
More Differentials
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