Avascular Necrosis and Legg-Calve’-Perthes Disease

What age group is most commonly affected by Avascular Necrosis if it is not related to a fracture?

Legg-Calve’-Perthes Disease is a non-inflammatory disorder that self-resolves.

What is one long-term complication associated with Legg-Calve’-Perthes Disease?

Avascular necrosis may occur as a secondary complication to a fracture of the femoral head or ______.

Match the following stages of Legg-Calve’-Perthes Disease with their descriptions:

Which gender is more commonly affected by Legg-Calve’-Perthes Disease?

The weight-bearing surface of the femoral head flattens in Avascular Necrosis.

What is the medical term for the painful gait observed in individuals with Legg-Calve’-Perthes Disease?

The term _____ refers to the flat appearance of the femoral head in Legg-Calve'-Perthes Disease.

During which stage of Legg-Calve’-Perthes Disease does the joint become inflamed, stiff, and painful?

Avascular Necrosis (AVN)

Can occur as a complication of a femoral head or neck fracture.
If not related to a fracture, it typically affects individuals between 20 and 50 years old.
The cause is often unknown but is more common in men and frequently affects both hips (bilateral).
After initial tissue death (infarction), the femoral head collapses, fragments, and heals with deformity, leading to osteoarthritis.

Legg-Calve’-Perthes (LCP) Disease (Coxa Plana)

A self-limiting disorder characterized by degeneration of the femoral head due to disrupted blood supply (avascular necrosis).
A portion of the femoral head undergoes avascular necrosis, causing the weight-bearing surface to flatten (coxa plana).
The necrotic bone is eventually reabsorbed and replaced by new bone.
The cause is unknown but may be related to trauma, genetics, inflammation of the joint lining (synovitis), vascular abnormalities, or infection.
Four times more common in males than females, typically affecting children between the ages of 4 and 8.
A long-term complication is osteoarthritis due to the uneven joint surfaces.

Stages of Legg-Calve’-Perthes Disease

Condensation/Necrosis: The femoral head's blood supply is disrupted, leading to inflammation, stiffness, and pain. This stage lasts for several months to a year.
Fragmentation: The body removes dead bone cells and replaces them with new bone cells. The joint remains stiff and painful. This stage lasts for 1-2 years.
Re-ossification: Blood supply is restored, allowing new bone growth. This stage lasts for 2-3 years.
Remodeling: Normal bone replaces new bone cells. The femoral head may become mushroom-shaped or flattened (coxa plana).

Clinical Features of Legg-Calve’-Perthes Disease

Gradual onset of symptoms.
Painful walking, leading to an antalgic gait (a limp).
Pain relieved by rest.
Positive Trendelenburg sign (due to weakness of the gluteus medius muscle).
Decreased range of motion in the hip joint.
Pain at extreme movements.
Tenderness over the front of the hip.

This quiz covers key concepts related to Avascular Necrosis (AVN) and Legg-Calve’-Perthes (LCP) Disease, including their causes, demographics, and effects on the femoral head. Test your understanding of these conditions, their implications, and the differences between them. Ideal for students studying orthopedics or related medical fields.