Catterall classification of Perthes disease

Last revised by Rohit Sharma on 7 Feb 2020

The Catterall classification of Perthes disease is based on radiographic appearances of the epiphysis and metaphysis visible in osteonecrosis of the femoral head:

  • stage I
    • bone absorption changes visible in the anterior aspect of the epiphysis of femoral head
    • changes are visible best in frog leg lateral view
    • no sclerosis is seen
  • stage II
    • further bone resorption with slight femoral head collapse in the anterior aspect of femoral head
    • sclerosis
  • stage III
    • almost entire femoral head involved in collapse with characteristic head within head appearance
    • sclerosis
  • stage IV
    • complete collapse of femoral head with flattening and formation of dense sclerosis; additional metaphyseal changes may be visible
    • sclerosis
    • posterior remodeling

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