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• W3202044412 abstract "<h3>Background</h3> Legg-Calves-Perthes (LCP) disease, or Perthes’ disease, has been present since prehistoric times, with paleopathologists identifying what is believed to be the most ancient case in 6th to 3rd Century BC Italy. Nevertheless, it was over two millennia later in the early 20th Century that LCP was named and its aetiology investigated. The historical development of LCP represents only a part of the wider development in paediatric orthopaedics occurring at the time, a period revolutionised by Rontgen’s discovery of X-rays in 1895. <h3>Objectives</h3> A historical overview of Legg-Calves-Perthes disease. <h3>Methods</h3> Literature review. <h3>Results</h3> Early research of paediatric hip conditions centred on direct visualisation under anaesthesia, biopsy and clinical assessment. Rokitansky, an 18th century pathologist, is now believed to have incorrectly ascribed some early cases of LCP as hip infection and tuberculosis, both conditions predominant at the time. The lack of radiographic imaging provided a stumbling block to the identification of LCP and it is retrospectively believed that many cases of LCP were incorrectly diagnosed as hip infection, tuberculosis, slipped upper femoral epiphysis, and osteochondritis. Rontgen’s discovery of X-rays in 1895 revolutionised orthopaedics to what it has become today. From 1909 to 1910 the first formal descriptions of LCP dutifully followed from A. Legg in the USA, J. Calve in France, and G. Perthes in Germany. While united in their radiographic descriptions, they differed greatly in the pathophysiology they postulated. Trauma, abnormal osteogenesis and inflammation were all proposed, but are now considered incorrect. Rather it was histological studies by Phemister in Chicago, in 1921, that first suggested an aseptic cause of necrosis of the femoral head. This concept was furthered by Konjetzny in 1926, who demonstrated a compromised vascular supply to the femoral head of patients with LCP. In the next stage of radiographic assessment, Waldenstrom in 1922 was able to build on the work of Phemister and described four radiographic stages of LCP disease: initial, fragmentation, re-ossification and healed. These stages still hold true today, demonstrating remarkable insight, and have only recently been modified in 2003 by Joseph et al, giving rise to the <i>modified</i>- Waldenstrom classification system. Later work by Stulberg in 1981 resulted in the Stulberg classification, an important prognosticating classification used today. The management of LCP has evolved from two early schools of opinion: unloading of the hip to allow neovascularisation and containment of the hip. Early approaches focused on the former and resulted in prolonged bedrest, long admissions and poor compliance. Later efforts focused on containment and were first applied by Harrison et al, who in 1969 introduced the Birmingham hip abduction splint. Further orthoses by Petrie in 1971 and Curtis et al in 1974 followed, however suffered high complication and failure rates. Simultaneously, operative containment was being established and Soeure and De Racker introduced the femoral varus osteotomy in 1952, soon followed by Salter’s innominate osteotomy in 1962. <h3>Conclusions</h3> The history of LCP demonstrates the importance of ongoing research and debate to obtain sound understanding and improved outcomes in child health. Future work continues to optimise and advance existing knowledge." @default.
• W3202044412 created "2021-10-11" @default.
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• W3202044412 date "2021-09-30" @default.
• W3202044412 modified "2023-09-26" @default.
• W3202044412 title "1081 Legg-Calve-Perthes disease: a transatlantic effort" @default.
• W3202044412 doi "https://doi.org/10.1136/archdischild-2021-rcpch.381" @default.
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