osteonecrosis ug

Osteonecrosis

Avascular Necrosis of Hip&

Perthe’s Disease

Anatomy

Applied Anatomy

Causes

Pathogenesis

Pathology

Imaging

Sites..

Staging

Management

OSTEOCHONDROSIS (OSTEOCHONDRITIS)

Differential Diagnosis

AVN Hip

Anatomy

Retinacular Vessels

Clinical Features

• Pain

• Movement restriction

– Abduction

– Internal Rotation

X-Ray

Post Traumatic

MRI

Osteo Arthritis

STAGING

Core Decompression

Unloading Osteotomy

Arthroplasty

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

Progression

Clinical Features

• Pain

• Movement restriction– Abduction– Internal Rotation

• Limp

Herring’s Lateral Pillar Classification

Catterall’s Classification

Head at Risk Signs

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.

Children under 6 years

• No specific form of treatment has much

influence on the outcome.

• Symptomatic treatment, including activity

modification, is appropriate.

Children aged 6–8 years

• In this group the bone age is more important than the chronological age

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.

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.

Children 9 years and older

• Except in very mild cases (which is rare), operative

containment is the treatment of choice.

Aim of Treatment

CONTAINMENT

Abduction Splint

Innominate osteotomy

Femoral Osteotomy

Innominate Osteotomy

Combined

Thank You