Waldenström classification of Perthes disease

Last revised by Andrew Murphy on 31 Jul 2022

The Waldenström classification of Perthes disease refers to x-ray abnormalities and represents four temporal phases of the disease. These stages have been further subdivided in the modified Elizabethtown classification 2.

  • stage I: early
    • asymmetric femoral epiphyseal size (smaller on the 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
    • depending on the 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

History and etymology

The staging system originally described by J H Waldenström in 1922 had some differences in numbering (IA: initial stage, IB: fragmentation stage, II: healing period, III: growing period, IV: definite stage) 4. What is today widely known as Waldenström classification is probably better reflecting the classification used by S T Canale in 1972 5 and is therefore called Elizabethtown classification by some 2.

See also

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