Nuno Craveiro Lopes M.D. 

Head of Orthopedic and Traumatologic Department
Coordinator of Pediatric Orthopedics  and Limb Reconstructive Surgery Unit
Garcia de Orta Hospital, Almada - Portugal

Any comment, suggestion or contact can be done to: [email protected]

CLINICAL CASE PRESENTATION

Treatment of Legg-Calvé-Perthes disease utilizing arthrodiastasis with an Ilizarov frame (2001)

Perthes disease in children above 8 yo, generally has a worst prognosis. On this age group it is common that hinge abduction appears in a descentered and uncontained hip, situation that has a difficult solution with the standard surgical procedures. On those cases arthrodiastasis as described, can be a valuable treatment option.

The rationale of arthrodiastasis on Perthes is that it permits to reduce the hip, protect it during the fragmentation stage, and creating a space inside the acetabulum, permits the elastic memory of the articular cartilage to act over the collapsed plastic fragmented bone of the femoral head to regain its spherical shape.

The present case was one of a 8 yo boy with a Perthes disease on the right hip, complaining of pain, loss of movement and a hinge abduction effect on the hip. Xr showed a descentered and uncontained hip.

An Ilizarov frame with hinges centered on the center of rotation of the head, was assembled with the limb in a position of abduction and slight flexion,  permitting the reduction and containment of the hip, a progressive arthrodiastasis and flexion-extension movements.

The frame was used for 3 months. During this period one could assist to the progressive reshapping of the femoral head. After that period the hip was protected with an abduction-flexion brace for 8 months.

Those are the results 4 years after frame removal. Patient is asymptomatic, walking without any limp, movements are free and complete.