Perthes disease

Case contributed by Dr Abeer Ahmed Alhelali


Intermittent limping especially after exertion.

Patient Data

Age: 7 years
Gender: Male

Small capital femoral epiphysis noted in the right hip with sclerotic changes and minimal widening of the joint space.


Few months later

The patient was advised to have bed rest and not to overuse his limb, however, repeated x-ray showed fragmentation of right femoral capital epiphysis which has progressed from the earlier study with preserved acetabulum.

Case Discussion

Legg-Calve-Perthes Disease is idiopathic osteonecrosis of the capital femoral epiphysis, usually unilateral and occurs in young people as in our case. Seen mainly in males aged 4-8 years.

It can be staged with the Catterall classification:

  • stage I: clinical and histological diagnosis; no radiographic findings
  • stage II: sclerosis of epiphysis +/- cystic changes; contour and surface of femoral head are preserved
  • stage III: irregular epiphysis
  • stage IV: irregular epiphysis and acetabulum

Treatment is symptomatic, especially in the early stage of the disease. As the disease progresses, destruction and fragmentation of the femoral head occurs which needs operative management.

Special thanks to Dr Tamer Ibrahim Elholiby.

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Case information

rID: 51002
Published: 15th Feb 2017
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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