Legg Calves Perthes (LCP) and Slipped Capital Femoral Epiphysis for USMLE

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.

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