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Perthes' disease rarely occur after age 14 years (if diagnosed after 14 years of age, then it is usually old disease from early in childhood or avascular necrosis from an alternative cause). White northern
Europeans appear to be affected more frequently than other ethnicities, though a paucity of reliable epidemiology exists in the Southern Hemisphere. Children of those with the disease themselves may have a very slightly increased risk, though it is unclear if this is because of a genetic predisposition, or a shared environmental factor. It is most commonly seen in persons aged three to twelve years, with a median of six years of age. The UK incidence rates show an intriguing pattern with low incidence rates in London, and a progressive increase in disease in more northerly areas (maximal in Scotland). Some evidence suggests, at least in developed countries, more socioeconomically deprived communities have a greater risk of disease (a similar trend to diseases such as adult heart disease), though the reason for this remains unknown. One possible explanation that has been considered is tobacco smoke exposure, though this is significantly confounded by the strong socioeconomic gradient common to both smoking and Perthes' disease.
289:
disease is a vascular restrictive condition of idiopathic nature. Symptoms like femoral head disfigurement, flattening, and collapse occur typically between ages four and ten, mostly male children of
Caucasian descent. Children affected by LCP disease often display uneven gait and limited range of motion, and they experience mild to severe pain in the groin area. For example, a child may be six years old chronologically but may have grown only four years old in terms of bone maturity. The child may then engage in activities appropriate for a six-year-old child, but lacking the bone strength of an older child, these activities may lead to flattening or fracture of the hip joint. Genetics do not appear to be a determining factor, but a deficiency of blood factors with anticoagulant property used to disperse blood clots may lead to blockages in the vessels supplying the joint. A deficiency of
254:
rotation (with the knee flexed 90°, twisting the lower leg away from the center of the body). The range of motion is reduced, particularly in abduction and internal rotation, and the patient presents with a limp. Pain is usually mild. Atrophy of thigh muscles may occur from disuse and an inequality of leg length. In some cases, some activity can cause severe irritation or inflammation of the damaged area, including standing, walking, running, kneeling, or stooping repeatedly for an extended period. In cases exhibiting severe femoral osteonecrosis, pain is usually a chronic, throbbing sensation exacerbated by activity
265:). In some cases, pain is felt in the unaffected hip and leg, due to the children favoring their injured side and placing the majority of their weight on their "good" leg. It is predominantly a disease of boys (4:1 ratio). Perthes is generally diagnosed between 5 and 12 years of age, although it has been diagnosed as early as 18 months. Typically, the disease is only seen in one hip, but bilateral Perthes is seen in about 10% of children diagnosed.
522:
months, with a peak incidence around 7 months. The pathology of avascular necrosis followed by revascularization and bony remodeling of the femoral head in the dog certainly suggests a vascular etiology, though the cause of the condition is not completely understood. Hip pain is usually seen by the age of 6 to 8 months. The disease is bilateral in 12–16% of cases. X-rays are necessary to make the diagnosis and show increased opacity and focal
424:
is needed in the joint. As those affected age, problems in the knee and back can arise secondary to abnormal posture and stride adopted to protect the affected joint. The condition is also linked to arthritis of the hip, though this appears not to be an inevitable consequence. Hip replacements are relatively common as the already damaged hip experiences routine wear; this varies by individual, but generally is required any time after age 50.
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ten are at a very high risk of developing osteoarthritis and coxa magna. When an LCP disease diagnosis occurs after age eight, a better outcome results with surgery rather than nonoperative treatments. Shape of femoral head at the time when Legg-Calvé Perthes disease heals is the most important determinant of risk for degenerative arthritis; hence, the shape of femoral head and congruence of hip are most useful outcome measures.
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57:
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dysfunction, inflammation, nutrition, and altered circulatory hemodynamics. Risk factors are not limited to impaired and disproportionate growth, low birth weight, delayed skeletal maturity, short stature, systemic hormonal changes, and low economic index. Although no one has identified the cause of
Perthes disease, a reduction in blood flow to the joint is known.
416:
physiotherapist to monitor progress. These exercises focus on improving and maintaining a full range of motion of the femur within the hip socket. Performing these exercises during the healing process is essential to ensure that the femur and hip socket have a perfectly smooth interface. This will minimize the long-term effects of the disease. Use of
297:, which also act as blood anticoagulants, may also exist; if that were the case, their deficiency could cause clot formation in ligamentum teres femoris artery and hinder blood supply to the femoral head. However, no evidence of this has been found; over the years, many theories have been published, but none has stood up to professional research.
403:
contact sports or games which impact the hip. For older children (onset of
Perthes after age 6), the best treatment option remains unclear. Current treatment options for older children over age 8 include prolonged periods without weight bearing, osteotomy (femoral, pelvic, or shelf), and the hip distraction method using an
484:
hospital in
England, Scotland, and Wales which treats Perthes' disease is collecting details of new cases. This study is supported by Steps Charity Worldwide. The study is nationally approved by the UK ethics committee and NHS research approval teams in England, Scotland, and Wales. The study is funded by the
423:
Perthes disease is self-limiting, but if the head of femur is left deformed, long-term problems can occur. Treatment is aimed at minimizing damage while the disease runs its course, not at 'curing' the disease. It is recommended not to use steroids or alcohol as these reduce oxygen in the blood which
402:
and implemented by an orthotist. Clinical results of the
Scottish Rite orthosis have not been good according to some studies, and its use has gone out of favor. Many children, especially those with the onset of the disease before age 6, need no intervention at all and are simply asked to refrain from
288:
The disease is theorized to include the artery of the ligamentum teres femoris being constricted or even blocked too early, not allowing for time when the medial circumflex femoral artery takes over. The medial circumflex femoral artery is the principal source of blood supply to the femoral head. LCP
521:
can be affected. No sex predilection is seen in the dog as contrasted to humans, in whom an 80% male incidence of the disease is evident. Similar to children, however, the condition is usually unilateral, with only about 10–15% incidence of bilateral disease. The age of onset varies between 4 and 12
440:
Children younger than six have the best prognosis, since they have time for the dead bone to revascularize and remodel, with a good chance that the femoral head will recover and remain spherical after resolution of the disease. Children who have been diagnosed with
Perthes' disease after the age of
253:
The condition is most commonly found in children between the ages of 4 and 10. Common symptoms include pain in the hip, knee, or ankle (since hip pathology can cause pain to be felt in a normal knee or ankle), or in the groin; this pain is exacerbated by hip or leg movement, especially internal hip
449:
Perthes' disease is one of the most common hip disorders in young children, occurring in roughly 5.5 of 100,000 children per year. The lifetime risk of a child developing the disease is about one per 1,200 individuals. Boys are affected about three to five times more often than girls. New cases of
483:
In the UK in 2016, a nationwide study began collecting details of every case of
Perthes' disease as part of the British Orthopaedic Surgery Surveillance Study. This aims to get core information about the disease, prior to starting extensive clinical trials about the best forms of treatment. Every
397:
may be used. Overnight traction may be used in lieu of walking devices or in combination. These devices internally rotate the femoral head and abduct the leg(s) at 45°. Orthoses can start as proximal as the lumbar spine, and extend the length of the limbs to the floor. Most functional bracing is
368:
or MRI may be useful in making the diagnosis in those cases where X-rays are inconclusive. Usually, plain radiographic changes are delayed six weeks or more from clinical onset, so bone scintigraphy and MRI are done for early diagnosis. MRI results are more accurate, i.e. 97–99% against 88–93% in
377:
The goals of treatment are to decrease pain, reduce the loss of hip motion, and prevent or minimize permanent femoral head deformity so that the risk of developing a severe degenerative arthritis as an adult can be reduced. Assessment by a pediatric orthopaedic surgeon is recommended to evaluate
496:
LCP disease is an avascular necrosis of the femoral head in small-breed dogs, usually those weighing up to 25 lbs. LCP disease was first described in veterinary literature by Tutt in 1935. Tutt described the disease as almost exactly what
Waldenstromin (1909) described in humans. Small breeds,
284:
Legg believed the cause was impairment of blood supply to the femoral epiphysis, Calvé believed rickets, and
Perthes deduced an infection possibly causing degenerative arthritis leads to LCP disease. Currently, a number of factors have been implicated, including heredity, trauma, endocrine
415:
is highly recommended, as it allows exercise of the hip muscles with full range of motion while reducing the stress to a minimum. Cycling is another good option as it also keeps stress to a minimum. Physiotherapy generally involves a series of daily exercises, with weekly meetings with a
232:
The condition is most commonly found in children between the ages of 4 and 8, but it can occur in children between the ages of 2 and 15. It can produce a permanent deformity of the femoral head, which increases the risk of developing
469:
1910: The disease was recognized as being unrelated to tuberculosis by three physicians working independently. Legg–Calvé–Perthes is named after these three doctors: Arthur Legg (1874–1939), Jacques Calvé (1875–1954), and
530:, but conservative treatment (rest, exercise restriction, and pain medication) may be effective in a limited number of cases (less than 25%, according to some studies). In dogs, the prognosis is excellent with surgery.
348:
which only affects the hip, although other forms of osteochondritis can affect elbows, knees, ankles, and feet. Bilateral Perthes, which means both hips are affected, should always be investigated thoroughly to rule out
1121:
Johannesen J, Briody J, McQuade M, Little DG, Cowell CT, Munns CF (November 2009). "Systemic effects of zoledronic acid in children with traumatic femoral head avascular necrosis and Legg-Calve-Perthes disease".
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While running and high-impact sports are not recommended during treatment for Perthes disease, children can remain active through a variety of other activities that limit mechanical stress on the hip joint.
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and a weakening of the femoral head. The bone loss leads to some degree of collapse and deformity of the femoral head and sometimes secondary changes to the shape of the hip socket.
722:
Bahmanyar S, Montgomery SM, Weiss RJ, Ekbom A (August 2008). "Maternal smoking during pregnancy, other prenatal and perinatal factors, and the risk of Legg-Calvé-Perthes disease".
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plain radiography. If MRI or bone scans are necessary, a positive diagnosis relies upon patchy areas of vascularity to the capital femoral epiphysis (the developing femoral head).
1464:
Perry DC, Bruce CE, Pope D, Dangerfield P, Platt MJ, Hall AJ (December 2012). "Perthes' disease of the hip: socioeconomic inequalities and the urban environment".
17:
273:
Perthes disease is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. Due to the lack of blood flow, the bone dies (
933:
Laine JC, Martin BD, Novotny SA, Kelly DM (August 2018). "Role of Advanced Imaging in the Diagnosis and Management of Active Legg-Calvé-Perthes Disease".
225:) and stops growing. Over time, healing occurs by new blood vessels infiltrating the dead bone and removing the necrotic bone which leads to a loss of
1591:
Chou DT, Ramachandran M (2016). "Chapter 7: Legg-Calvé-Perthes' disease: Historical note". In Aresti NA, Ramachandran M, Paterson JM, Barry M (eds.).
485:
1312:"Legg-Calvé-Perthes disease in the UK: geographic and temporal trends in incidence reflecting differences in degree of deprivation in childhood"
1157:
Seufert CR, McGrory BJ (October 2015). "Treatment of Arthritis Associated With Legg-Calve-Perthes Disease With Modular Total Hip Arthroplasty".
811:
Vosmaer A, Pereira RR, Koenderman JS, Rosendaal FR, Cannegieter SC (January 2010). "Coagulation abnormalities in Legg-Calvé-Perthes disease".
217:) is a childhood hip disorder initiated by a disruption of blood flow to the head of the femur. Due to the lack of blood flow, the bone dies (
1833:
1644:
Wainwright AM, Catterall A (2010). "Capter 27: Legg–Calvé–Perthes disease: Its name". In Benson M, Fixsen J, MacNicol M, Parsch K (eds.).
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Treatment has historically centered on removing mechanical pressure from the joint until the disease has run its course. Options include
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Balasa VV, Gruppo RA, Glueck CJ, Wang P, Roy DR, Wall EJ, et al. (December 2004). "Legg-Calve-Perthes disease and thrombophilia".
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of the hip may suggest and/or verify the diagnosis. X-rays usually demonstrate a flattened, and later fragmented, femoral head. A
305:
Over time, healing occurs by new blood vessels infiltrating the dead bone and removing the necrotic bone which leads to a loss of
261:, and limping or other joint guarding, particularly when tired. The pain is usually in the hip, but can also be felt in the knee (
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in the head of the femur, and later in the disease, collapse and fracture of the neck of the femur. The recommended treatment is
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achieved using a waist belt and thigh cuffs derived from the Scottish-Rite orthosis. These devices are typically prescribed by a
1600:
1507:
Kealey WD, Moore AJ, Cook S, Cosgrove AP (March 2000). "Deprivation, urbanisation and Perthes' disease in Northern Ireland".
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393:, and surgical intervention when necessary because of permanent joint damage. To maintain activities of daily living, custom
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which affects only the hip. Bilateral Perthes, which means both hips are affected, should always be investigated to rule out
1351:
Perry DC, Bruce CE, Pope D, Dangerfield P, Platt MJ, Hall AJ (December 2011). "Perthes' disease: deprivation and decline".
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such as zoledronate or ibandronate is currently being investigated, but definite recommendations are not yet available.
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is unknown.Perthes can produce a permanent deformity of the femoral head, which increases the risk of developing
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which relieves the hip from carrying the body's weight. This allows room for the top of the femur to regrow.
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242:
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Kim HK, Herring JA (July 2011). "Pathophysiology, classifications, and natural history of Perthes disease".
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2019:
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1268:"Racial and geographic factors in the incidence of Legg-Calvé-Perthes' disease: a systematic review"
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Pain in the hip, knee, ankle (hip pathology can refer pain to a normal knee or ankle), or groin.
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1909: Henning Waldenström (1877–1972) described the disease, attributing it to tuberculosis.
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risks and treatment options. Younger children have a better prognosis than older children.
8:
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Perry DC, Machin DM, Pope D, Bruce CE, Dangerfield P, Platt MJ, Hall AJ (February 2012).
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The first signs are complaints of soreness from the child, which are often dismissed as
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1544:"Environmental tobacco and wood smoke increase the risk of Legg-Calvé-Perthes disease"
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X ray of deformity by Legg–Calvé–Perthes disease of the right hip (left side of X-ray)
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389:(often for several months, with an average of 18 months) to restore range of motion,
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Joseph B (July 2011). "Prognostic factors and outcome measures in Perthes disease".
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Artery of the ligmentum teres femoris being constricted or even blocked too early
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1936:
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1980:
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1198:. Step-Up Series. Hagerstwon, MD: Lippincott Williams & Wilkins. p.
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1074:"Evidence for using bisphosphonate to treat Legg-Calvé-Perthes disease"
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27:
Osteochondrosis that results in death and fracture located in hip joint
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385:(to separate the femur from the pelvis and reduce wear),
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717:
715:
713:
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1114:
1811:
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579:
328:since the cause of the interruption of the
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2020:
1652:(3rd ed.). London: Springer. p.
1548:Clinical Orthopaedics and Related Research
1428:
1078:Clinical Orthopaedics and Related Research
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710:
691:
55:
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1838:. J.B. Lippincott Company. Archived from
1831:
1743:Mostofi SB, ed. (2005). "Georg Perthes".
1710:Mostofi SB, ed. (2005). "Jacques Calvé".
1567:
1327:
1283:
1097:
901:
668:
658:
528:surgical removal of the head of the femur
459:1897: The disease was first described by
1897:Textbook of Veterinary Internal Medicine
431:
2267:Hypertrophic pulmonary osteoarthropathy
1918:
1916:
1742:
1709:
1676:
1615:
1013:The Orthopedic Clinics of North America
978:The Orthopedic Clinics of North America
763:
761:
696:. Williams & Wilkins. p. 995.
204:1/25,000 in boys and 1/100,000 in girls
14:
2703:
1010:
478:
2015:
1835:Textbook of Small Animal Orthopaedics
1648:Children's orthopaedics and fractures
643:"Legg-Calvé-Perthes disease overview"
248:
229:and a weakening of the femoral head.
1913:
1792:
1056:
758:
848:
767:
24:
1969:Deutsches Ärzteblatt International
1955:
622:Legg-Calve-Perthes Disease Imaging
488:(NIHR) and the Alder Hey Charity.
25:
2742:
2007:
1747:. London: Springer. p. 267.
1620:. London: Springer. p. 345.
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782:10.5435/00124635-201011000-00005
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344:in adults. Perthes is a form of
237:in adults. Perthes is a form of
76:
2328:Infantile cortical hyperostosis
1853:
1825:
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1609:
1584:
1535:
1500:
1457:
1422:
1387:
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1259:
1216:
1192:Agabegi ED, Agabegi SS (2008).
1150:
1065:
1050:
1039:
1004:
969:
926:
886:"Multiple epiphyseal dysplasia"
877:
444:
2262:Complex regional pain syndrome
1521:10.1302/0301-620x.82b2.0820167
1443:10.1302/0301-620X.71B2.2925740
804:
685:
614:
544:
13:
1:
1408:10.1302/0301-620X.60B4.711792
537:
534:tablets may also be helpful.
351:multiple epiphyseal dysplasia
243:multiple epiphyseal dysplasia
1718:. London: Springer. p.
1685:. London: Springer. p.
600:10.3928/00904481-20160310-03
515:West Highland White Terriers
427:
372:
356:
300:
7:
1822:as tuberculosis of the hip.
1159:The Journal of Arthroplasty
692:Yochum TR, Rowe LJ (1987).
36:Legg–Calvé–Perthes syndrome
18:Legg–Calvé–Perthes syndrome
10:
2747:
2465:Legg–Calvé–Perthes disease
1937:10.1016/j.cvsm.2005.05.002
1171:10.1016/j.arth.2015.04.025
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1059:Legg–Calvé-Perthes-Disease
660:10.1186/s13023-022-02275-z
453:
312:It is also referred to as
211:Legg–Calvé–Perthes disease
2711:Syndromes affecting bones
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2433:Osteochondritis dissecans
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2049:
1981:10.3238/arztebl.2009.0517
1595:. Springer. p. 105.
1560:10.1007/s11999-011-2180-8
1090:10.1007/s11999-011-2240-0
1025:10.1016/j.ocl.2011.03.004
990:10.1016/J.OCL.2011.04.007
200:
192:
182:
174:
166:
156:
144:
68:
63:
54:
40:
35:
2477:Osgood–Schlatter disease
2383:Relapsing polychondritis
2255:Osteonecrosis of the jaw
2082:Osteitis fibrosa cystica
1745:Who's who in orthopedics
1714:Who's who in orthopedics
1681:Who's who in orthopedics
1618:Who's who in orthopedics
1316:Arthritis and Rheumatism
947:10.5435/JAAOS-D-16-00856
903:10.5435/JAAOS-D-13-00173
268:
2193:Paget's disease of bone
2144:Vertebral osteomyelitis
491:
320:of the capital femoral
2043:Bone and joint disease
736:10.1542/peds.2008-0307
437:
2523:Scheuermann's disease
2399:Slipping rib syndrome
2221:Hajdu–Cheney syndrome
511:Jack Russell Terriers
435:
281:) and stops growing.
2316:Aneurysmal bone cyst
2272:Nonossifying fibroma
1061:. New York: Praeger.
863:10.2106/JBJS.J.01834
825:10.2106/JBJS.I.00157
49:Legg–Perthes disease
1195:Step-Up to Medicine
479:Research directions
332:of the head of the
2721:Skeletal disorders
2664:External resources
2548:Kienböck's disease
2304:Skeletal fluorosis
2250:Avascular necrosis
1975:(31–32): 517–523.
1285:10.1093/aje/kwr293
1046:http://www.nih.gov
503:Yorkshire Terriers
438:
279:avascular necrosis
249:Signs and symptoms
223:avascular necrosis
2731:Syndromes in dogs
2698:
2697:
2576:
2575:
2572:
2571:
2568:
2567:
2412:
2411:
2355:
2354:
2287:Fibrous dysplasia
2152:
2151:
1931:(5): 1111–35, v.
1602:978-1-4471-6767-9
1472:(12): 1053–1057.
1359:(12): 1124–1128.
1329:10.1002/art.34316
1231:(12): 2642–2647.
1209:978-0-7817-7153-5
1165:(10): 1743–1746.
208:
207:
184:Diagnostic method
30:Medical condition
16:(Redirected from
2738:
2580:
2579:
2538:
2514:
2482:Blount's disease
2455:
2448:
2447:
2421:
2420:
2366:
2365:
2231:Gorham's disease
2198:Hypophosphatasia
2105:
2075:
2065:
2064:
2056:
2055:
2036:
2029:
2022:
2013:
2012:
2002:
1992:
1949:
1948:
1920:
1911:
1910:
1892:
1886:
1885:
1857:
1851:
1850:
1848:
1847:
1829:
1823:
1821:
1809:
1803:
1802:
1790:
1784:
1783:
1781:
1779:
1773:www.boss.surgery
1765:
1759:
1758:
1740:
1734:
1733:
1717:
1707:
1701:
1700:
1684:
1674:
1668:
1667:
1651:
1641:
1632:
1631:
1613:
1607:
1606:
1588:
1582:
1581:
1571:
1554:(9): 2369–2375.
1539:
1533:
1532:
1504:
1498:
1497:
1461:
1455:
1454:
1426:
1420:
1419:
1391:
1385:
1384:
1348:
1342:
1341:
1331:
1322:(5): 1673–1679.
1307:
1298:
1297:
1287:
1263:
1257:
1256:
1220:
1214:
1213:
1189:
1183:
1182:
1154:
1148:
1147:
1118:
1112:
1111:
1101:
1084:(9): 2462–2475.
1069:
1063:
1062:
1054:
1048:
1043:
1037:
1036:
1008:
1002:
1001:
984:(3): 285–95, v.
973:
967:
966:
930:
924:
923:
905:
881:
875:
874:
846:
837:
836:
808:
802:
801:
765:
756:
755:
730:(2): e459–e464.
719:
708:
707:
689:
683:
682:
672:
662:
638:
629:
618:
612:
611:
594:(4): e144–e149.
588:Pediatric Annals
583:
577:
576:
548:
405:external fixator
136:
135:
132:
131:
128:
125:
122:
119:
116:
112:
111:
108:
105:
102:
99:
96:
92:
91:
88:
85:
82:
59:
33:
32:
21:
2746:
2745:
2741:
2740:
2739:
2737:
2736:
2735:
2701:
2700:
2699:
2694:
2693:
2659:
2658:
2591:
2577:
2564:
2534:
2529:
2508:
2503:
2497:Sever's disease
2451:
2437:
2425:Osteochondritis
2408:
2404:Tietze syndrome
2387:
2378:Costochondritis
2351:
2347:Pycnodysostosis
2282:Stress fracture
2235:
2208:Bone resorption
2202:
2148:
2098:
2093:
2068:
2045:
2040:
2010:
2005:
1958:
1956:Further reading
1953:
1952:
1921:
1914:
1907:
1893:
1889:
1858:
1854:
1845:
1843:
1830:
1826:
1810:
1806:
1791:
1787:
1777:
1775:
1767:
1766:
1762:
1755:
1741:
1737:
1730:
1708:
1704:
1697:
1675:
1671:
1664:
1642:
1635:
1628:
1614:
1610:
1603:
1589:
1585:
1540:
1536:
1505:
1501:
1462:
1458:
1427:
1423:
1392:
1388:
1349:
1345:
1308:
1301:
1264:
1260:
1221:
1217:
1210:
1190:
1186:
1155:
1151:
1119:
1115:
1070:
1066:
1057:Katz J (1984).
1055:
1051:
1044:
1040:
1009:
1005:
974:
970:
941:(15): 526–536.
931:
927:
882:
878:
847:
840:
809:
805:
776:(11): 676–686.
766:
759:
720:
711:
704:
690:
686:
639:
632:
619:
615:
584:
580:
549:
545:
540:
494:
481:
456:
447:
430:
375:
359:
346:osteochondritis
303:
271:
251:
239:osteochondritis
140:
113:
93:
79:
75:
45:Perthes disease
31:
28:
23:
22:
15:
12:
11:
5:
2744:
2734:
2733:
2728:
2723:
2718:
2713:
2696:
2695:
2692:
2691:
2680:
2668:
2667:
2665:
2661:
2660:
2657:
2656:
2645:
2634:
2623:
2608:
2592:
2587:
2586:
2584:
2583:Classification
2574:
2573:
2570:
2569:
2566:
2565:
2563:
2562:
2561:
2560:
2558:Panner disease
2552:
2551:
2550:
2541:
2539:
2531:
2530:
2528:
2527:
2526:
2525:
2517:
2515:
2505:
2504:
2502:
2501:
2500:
2499:
2494:
2492:Köhler disease
2486:
2485:
2484:
2479:
2469:
2468:
2467:
2458:
2456:
2445:
2439:
2438:
2436:
2435:
2429:
2427:
2418:
2414:
2413:
2410:
2409:
2407:
2406:
2401:
2395:
2393:
2389:
2388:
2386:
2385:
2380:
2374:
2372:
2363:
2357:
2356:
2353:
2352:
2350:
2349:
2344:
2343:
2342:
2340:Melorheostosis
2335:Osteosclerosis
2332:
2331:
2330:
2320:
2319:
2318:
2306:
2301:
2300:
2299:
2294:
2284:
2279:
2277:Pseudarthrosis
2274:
2269:
2264:
2259:
2258:
2257:
2252:
2243:
2241:
2237:
2236:
2234:
2233:
2228:
2223:
2218:
2212:
2210:
2204:
2203:
2201:
2200:
2195:
2190:
2185:
2180:
2179:
2178:
2168:
2162:
2160:
2154:
2153:
2150:
2149:
2147:
2146:
2141:
2136:
2134:Brodie abscess
2131:
2126:
2125:
2124:
2119:
2108:
2106:
2095:
2094:
2092:
2091:
2090:
2089:
2078:
2076:
2062:
2053:
2047:
2046:
2039:
2038:
2031:
2024:
2016:
2009:
2008:External links
2006:
2004:
2003:
1959:
1957:
1954:
1951:
1950:
1912:
1905:
1887:
1868:(5): 918–930.
1852:
1824:
1804:
1785:
1760:
1753:
1735:
1728:
1702:
1695:
1669:
1662:
1633:
1626:
1608:
1601:
1583:
1534:
1515:(2): 167–171.
1499:
1456:
1437:(2): 229–233.
1421:
1402:(4): 478–480.
1386:
1343:
1299:
1278:(3): 159–166.
1258:
1215:
1208:
1184:
1149:
1130:(5): 898–902.
1113:
1064:
1049:
1038:
1003:
968:
925:
896:(3): 164–172.
876:
857:(7): 659–669.
838:
819:(1): 121–128.
803:
757:
709:
702:
684:
630:
613:
578:
559:(5): 778–788.
542:
541:
539:
536:
493:
490:
480:
477:
476:
475:
467:
464:
455:
452:
446:
443:
429:
426:
418:bisphosphonate
374:
371:
358:
355:
342:osteoarthritis
302:
299:
270:
267:
250:
247:
235:osteoarthritis
206:
205:
202:
198:
197:
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190:
189:
186:
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72:
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60:
52:
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42:
38:
37:
29:
26:
9:
6:
4:
3:
2:
2743:
2732:
2729:
2727:
2726:Osteonecrosis
2724:
2722:
2719:
2717:
2716:Rare diseases
2714:
2712:
2709:
2708:
2706:
2690:
2686:
2685:
2681:
2679:
2675:
2674:
2670:
2669:
2666:
2662:
2655:
2651:
2650:
2646:
2644:
2640:
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2635:
2633:
2629:
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2624:
2622:
2618:
2617:
2613:
2609:
2607:
2603:
2602:
2598:
2594:
2593:
2590:
2585:
2581:
2559:
2556:
2555:
2553:
2549:
2546:
2545:
2543:
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2540:
2537:
2532:
2524:
2521:
2520:
2519:
2518:
2516:
2513:
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2506:
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2459:
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2397:
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2333:
2329:
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2325:
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2321:
2317:
2314:
2313:
2312:
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2307:
2305:
2302:
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2293:
2290:
2289:
2288:
2285:
2283:
2280:
2278:
2275:
2273:
2270:
2268:
2265:
2263:
2260:
2256:
2253:
2251:
2248:
2247:
2245:
2244:
2242:
2238:
2232:
2229:
2227:
2224:
2222:
2219:
2217:
2214:
2213:
2211:
2209:
2205:
2199:
2196:
2194:
2191:
2189:
2186:
2184:
2181:
2177:
2174:
2173:
2172:
2169:
2167:
2164:
2163:
2161:
2159:
2155:
2145:
2142:
2140:
2137:
2135:
2132:
2130:
2127:
2123:
2120:
2118:
2115:
2114:
2113:
2112:Osteomyelitis
2110:
2109:
2107:
2104:
2102:
2096:
2088:
2085:
2084:
2083:
2080:
2079:
2077:
2074:
2072:
2066:
2063:
2061:
2057:
2054:
2052:
2048:
2044:
2037:
2032:
2030:
2025:
2023:
2018:
2017:
2014:
2000:
1996:
1991:
1986:
1982:
1978:
1974:
1970:
1966:
1961:
1960:
1946:
1942:
1938:
1934:
1930:
1926:
1919:
1917:
1908:
1906:0-7216-7258-2
1902:
1898:
1891:
1883:
1879:
1875:
1871:
1867:
1863:
1856:
1842:on 2011-09-05
1841:
1837:
1836:
1828:
1819:
1815:
1808:
1800:
1796:
1789:
1774:
1770:
1764:
1756:
1754:9781852337865
1750:
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1731:
1729:9781852337865
1725:
1721:
1716:
1715:
1706:
1698:
1696:9781852337865
1692:
1688:
1683:
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1665:
1663:9781848826106
1659:
1655:
1650:
1649:
1640:
1638:
1629:
1627:9781852337865
1623:
1619:
1612:
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1510:
1503:
1495:
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1487:
1483:
1479:
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1471:
1467:
1460:
1452:
1448:
1444:
1440:
1436:
1432:
1425:
1417:
1413:
1409:
1405:
1401:
1397:
1390:
1382:
1378:
1374:
1370:
1366:
1362:
1358:
1354:
1347:
1339:
1335:
1330:
1325:
1321:
1317:
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1250:
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1230:
1226:
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1211:
1205:
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1197:
1196:
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1141:
1137:
1133:
1129:
1125:
1117:
1109:
1105:
1100:
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1091:
1087:
1083:
1079:
1075:
1068:
1060:
1053:
1047:
1042:
1034:
1030:
1026:
1022:
1019:(3): 303–15.
1018:
1014:
1007:
999:
995:
991:
987:
983:
979:
972:
964:
960:
956:
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725:
718:
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714:
705:
703:0-683-09329-0
699:
695:
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680:
676:
671:
666:
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656:
652:
648:
644:
637:
635:
628:
624:
623:
617:
609:
605:
601:
597:
593:
589:
582:
574:
570:
566:
562:
558:
554:
547:
543:
535:
533:
529:
525:
520:
516:
512:
508:
504:
500:
497:particularly
489:
487:
473:
472:Georg Perthes
468:
465:
462:
458:
457:
451:
442:
434:
425:
421:
419:
414:
408:
406:
401:
396:
392:
391:physiotherapy
388:
384:
379:
370:
367:
363:
354:
352:
347:
343:
339:
335:
331:
327:
323:
319:
318:osteonecrosis
315:
310:
308:
298:
296:
292:
286:
282:
280:
276:
275:osteonecrosis
266:
264:
263:referred pain
260:
259:growing pains
255:
246:
244:
240:
236:
230:
228:
224:
220:
219:osteonecrosis
216:
212:
203:
199:
195:
191:
187:
185:
181:
177:
173:
169:
165:
161:
159:
155:
152:
149:
147:
143:
134:
74:
73:
71:
69:Pronunciation
67:
62:
58:
53:
50:
46:
43:
39:
34:
19:
2682:
2671:
2647:
2636:
2625:
2610:
2595:
2535:
2509:
2464:
2452:
2323:Hyperostosis
2308:
2188:Osteomalacia
2171:Osteoporosis
2166:Bone density
2129:Sesamoiditis
2099:
2069:
2060:Inflammation
1972:
1968:
1928:
1924:
1896:
1890:
1865:
1861:
1855:
1844:. Retrieved
1840:the original
1834:
1827:
1817:
1813:
1807:
1798:
1794:
1788:
1776:. Retrieved
1772:
1763:
1744:
1738:
1713:
1705:
1680:
1672:
1647:
1617:
1611:
1592:
1586:
1551:
1547:
1537:
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1465:
1459:
1434:
1430:
1424:
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1356:
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1346:
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1275:
1271:
1261:
1228:
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650:
646:
620:
616:
591:
587:
581:
556:
552:
546:
532:Prednisolone
495:
482:
474:(1869–1927).
463:(1853–1903).
448:
445:Epidemiology
439:
422:
409:
380:
376:
360:
330:blood supply
326:femoral head
311:
304:
287:
283:
272:
256:
252:
231:
214:
210:
209:
170:4 to 8 years
48:
44:
2673:MedlinePlus
2297:Polyostotic
2139:Periostitis
2087:Brown tumor
1814:Orthop Chir
1778:28 February
499:Toy Poodles
461:Karel Maydl
167:Usual onset
151:Orthopedics
41:Other names
2705:Categories
2649:DiseasesDB
2370:Chondritis
2292:Monostotic
2246:Ischaemia
2216:Osteolysis
2183:Osteopenia
2122:Involucrum
2117:Sequestrum
1846:2011-12-04
724:Pediatrics
653:(1): 125.
538:References
519:Dachshunds
316:avascular
314:idiopathic
2689:radio/387
2684:eMedicine
2310:bone cyst
2158:Metabolic
2101:infection
2071:endocrine
1381:206853890
627:eMedicine
428:Prognosis
400:physician
395:orthotics
373:Treatment
366:bone scan
357:Diagnosis
338:hip joint
322:epiphysis
307:bone mass
301:Pathology
295:protein S
291:protein C
227:bone mass
201:Frequency
196:Orthotics
193:Treatment
146:Specialty
2417:Combined
2176:Juvenile
1999:19730720
1945:16129135
1882:14036446
1578:22090357
1529:10755420
1494:30496559
1486:23104772
1373:22080458
1338:22143958
1294:22223709
1253:30054597
1245:15590848
1179:25979188
1144:19446052
1108:22270467
1033:21742142
998:21742140
963:49417062
955:29939867
920:38168231
912:25667404
871:22488623
833:20048104
798:42235121
790:21041802
752:12645569
744:18625663
679:35292045
608:27064472
413:Swimming
383:traction
158:Symptoms
2643:D007873
1990:2735835
1795:Vet Rec
1569:3830089
1451:2925740
1099:3830104
670:8922924
573:2045406
454:History
336:in the
324:of the
2678:001264
2632:150600
2554:elbow
2544:wrist
2226:Ainhum
1997:
1987:
1943:
1903:
1880:
1820:: 487.
1801:: 428.
1751:
1726:
1693:
1660:
1624:
1599:
1576:
1566:
1527:
1492:
1484:
1449:
1416:711792
1414:
1379:
1371:
1336:
1292:
1251:
1243:
1206:
1177:
1142:
1106:
1096:
1031:
996:
961:
953:
918:
910:
869:
831:
796:
788:
750:
742:
700:
677:
667:
606:
571:
517:, and
387:braces
362:X-rays
175:Causes
137:
2621:732.1
2606:M91.1
2511:spine
2488:foot
2472:tibia
2443:Child
2392:Other
2361:Joint
2240:Other
1490:S2CID
1377:S2CID
1249:S2CID
959:S2CID
916:S2CID
794:S2CID
748:S2CID
524:lysis
334:femur
269:Cause
188:X-Ray
2654:9891
2638:MeSH
2627:OMIM
2616:9-CM
2536:arm:
2461:hip
2453:leg:
2051:Bone
1995:PMID
1941:PMID
1901:ISBN
1878:PMID
1866:44-A
1780:2016
1749:ISBN
1724:ISBN
1691:ISBN
1658:ISBN
1622:ISBN
1597:ISBN
1574:PMID
1525:PMID
1482:PMID
1447:PMID
1412:PMID
1400:60-B
1369:PMID
1334:PMID
1290:PMID
1241:PMID
1204:ISBN
1175:PMID
1140:PMID
1124:Bone
1104:PMID
1029:PMID
994:PMID
951:PMID
908:PMID
867:PMID
829:PMID
786:PMID
740:PMID
698:ISBN
675:PMID
604:PMID
569:PMID
507:Pugs
492:Dogs
293:and
215:LCPD
2612:ICD
2597:ICD
1985:PMC
1977:doi
1973:106
1933:doi
1870:doi
1687:189
1654:465
1564:PMC
1556:doi
1552:470
1517:doi
1474:doi
1439:doi
1404:doi
1361:doi
1324:doi
1280:doi
1276:175
1233:doi
1167:doi
1132:doi
1094:PMC
1086:doi
1082:470
1021:doi
986:doi
943:doi
898:doi
859:doi
821:doi
778:doi
732:doi
728:122
665:PMC
655:doi
625:at
596:doi
561:doi
277:or
221:or
121:ɜːr
47:or
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