osteonecrosis ug
TRANSCRIPT
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Osteonecrosis
Avascular Necrosis of Hip&
Perthe’s Disease
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Anatomy
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Applied Anatomy
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Causes
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Pathogenesis
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Pathology
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Imaging
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Sites..
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Staging
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Management
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OSTEOCHONDROSIS (OSTEOCHONDRITIS)
Differential Diagnosis
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AVN Hip
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Anatomy
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Retinacular Vessels
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Clinical Features
• Pain
• Movement restriction
– Abduction
– Internal Rotation
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X-Ray
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Post Traumatic
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MRI
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Osteo Arthritis
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STAGING
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Core Decompression
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Unloading Osteotomy
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Arthroplasty
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PERTHES’ DISEASE
• Perthes’ disease – or rather Legg–
Calvé–Perthes disease.
• 1910-the condition was described
independently by three different
people
• is a painful disorder of childhood
characterized by avascular
necrosis of the femoral head
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Progression
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Clinical Features
• Pain
• Movement restriction– Abduction– Internal Rotation
• Limp
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Herring’s Lateral Pillar Classification
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Catterall’s Classification
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Head at Risk Signs
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GUIDELINES TO TREATMENT
• based on an assessment of
– the stage of the disease,
– the prognostic x-ray classifications,
– the age of the patient
– The clinical features, particularly range of
abduction and extension.
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Children under 6 years
• No specific form of treatment has much
influence on the outcome.
• Symptomatic treatment, including activity
modification, is appropriate.
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Children aged 6–8 years
• In this group the bone age is more important than the chronological age
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Bone age at or below 6 years
• Lateral pillar group A and B (or Catterall stage I and II) – symptomatic treatment.
• Lateral pillar group C (or Catterall stage III and IV) – abduction brace.
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Bone age over 6 years
• Lateral pillar group A and B (Catterall stage I and II)
– abduction brace or osteotomy.
• Lateral pillar group C (Catterall stage III and IV)
–outcome probably unaffected by treatment, but some would operate.
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Children 9 years and older
• Except in very mild cases (which is rare), operative
containment is the treatment of choice.
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Aim of Treatment
CONTAINMENT
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Abduction Splint
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Innominate osteotomy
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Femoral Osteotomy
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Innominate Osteotomy
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Combined
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Thank You