Image of the Month: Unilateral Thigh Pain in 9-Year-Old Male

Nate Haas, MSIII


June 03, 2013

In This Article


Answer: Legg-Calvé-Perthes disease

Legg-Calvé-Perthes disease (LCP) is a syndrome of idiopathic avascular necrosis of the femoral head that presents most frequently in children ages 3-12 years-old. Males are affected more often than females, and Caucasians more often than African-Americans.[1] The exact pathophysiology remains unclear, but several predisposing factors and conditions have been postulated to play a role in the development of LCP. Inherited coagulopathies, especially Factor V Leiden, have been thought to be more prevalent in children with LCP, although this claim remains controversial.[2] Second-hand smoke exposure is another proposed risk factor.[3] Children whose bone development lags behind that of their peers have demonstrated an increased susceptibility to LCP.[4]

This is in contrast to slipped capital femoral epiphysis (SCFE), which is more likely to occur in an obese female child after minor trauma. A common presentation of SCFE is simultaneous external rotation and abduction of the hip to relieve the discomfort.

The figure demonstrates advanced disease, and the characteristic avascular necrosis of the femoral head seen above is often not present on plain films initially. It is important to remember that children with early stage LCP often present with pain and with no radiologic evidence of damage to the boney structures of the hip. Thus, a high index of suspicion for LCP must remain when evaluating children with lower extremity pain or limp.

Current treatment for LCP consists of making the child non-weight-bearing, splinting, and referral to a pediatric orthopedic surgeon.