Pathoanatomical Factors Responsible for Femoral Shortening in Legg-Calve-Perthes Disease / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to determine the relative contributions made by pathoanatomical factors responsible for femoral shortening in Legg-Calve-Perthes disease (LCPD), and to devise a method of reducing the amount of residual shortening based on a better understanding of its pathoanatomy and developmental pattern in LCPD. MATERIALS AND METHODS: We measured shortening of three anatomical components, namely, the femoral epiphysis, neck, and diaphysis on the teleoroentgenograms of 106 LCPD patients, comprised of 35 children with active disease, 24 in the healing stage, and 47 at skeletal maturity. RESULTS: The proportional contributions made by these 3 anatomical components to residual shortening at skeletal maturity were; 20% by the epiphysis (epiphyseal flattening), 53% by the neck (physeal growth retardation), and 27% by the diaphysis (underuse atrophy). These contributions differed according to disease stage and shortening severity. Mean diaphyseal shortening was 3.9 mm at skeletal maturity, but this increased to 5.8 mm when only patients with severe shortening (20 mm or more) were included. CONCLUSION: Our findings suggest that diaphyseal shortening is likely to be minimized by the implementation of limb exercise programs.

Responsible Factors for Femoral Shortening in Piglet Legg-Calve-Perthes Disease Models / 대한정형외과학회잡지

PURPOSE: To know the proportional contribution of causative factors to the femoral shortening in Legg-Calve-Perthes disease. MATERIALS AND METHODS: In twenty piglets, 4 to 5 weeks old, vascular supply to the capital femoral epiphysis was interrupted by ligating the femoral neck containing the epiphyseal artery. RESULTS: Mean femoral shortening in piglets sacrificed at 4 weeks after devascularization was 7.4 mm. In detail, the shortening was 2.5 mm (34%) in the epiphysis and 4.9 mm (66%) in the neck and diaphysis. Mean femoral shortening in piglets sacrificed at 8 weeks after operation was 12.1 mm. The distribution of shortening was 4.6 mm (38%) in the epiphysis and 7.5 mm (62%) in the neck and diaphysis. Mean femoral shortening in piglets sacrificed at 20 weeks after operation was 20.7 mm. The distribution of shortening was 4.0 mm (19%) in the epiphysis and 16.7 mm (81%) in the neck and diaphysis. CONCLUSION: We determined the proportional contribution to the residual shortening according to the causative factors.