Staging of Legg-Calvé-Perthes disease

Staging of Legg-Calve-Perthes syndrome refers to x-ray abnormalities, and represents 4 phases of the disease:

  • stage I: early
    • asymmetric femoral epiphyseal size (smaller on affected side)
    • apparent increased density of the femoral head epiphysis
    • widening of the medial joint space
    • blurring of the physeal plate
    • radiolucency of the proximal metaphysis
  • stage II: fragmentation
    • subchondral lucency (crescent sign)
    • femoral epiphysis fragments
    • femoral head outline is difficult to make out
    • mottled density
    • thickened trabeculae
  • stage III: reparative
    • re-ossification begins
    • shape of the femoral head becomes better defined
    • bone density begins to return
  • stage IV: healed
    • changes depend on severity the femoral head may be nearly normal or may demonstrate
      • flattening of the articular surface, especially superiorly
      • widening of the head and neck of the femur

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