Paeds Vivas · rheumatology-musculoskeletal-and-sports
Perthes disease — branching viva
Branching viva on Legg-Calve-Perthes disease: the four radiographic phases of idiopathic avascular necrosis, the Herring lateral pillar classification, the containment principle, and the age-and-pillar-guided surgical decision, including the older child at onset and the high-risk lateral pillar C head.
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RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
Outpatient clinic: a six-year-old boy with a three-week limp that comes and goes, worse after activity, who points to his right knee when asked where it hurts, and whose hip loses abduction and internal rotation. The examiner asks: describe your diagnostic approach, give your likely diagnosis and its pathophysiological basis, and outline the management — then branches to the Herring lateral pillar classification, the containment decision by age and pillar grade, the older child at onset, and finally to a nine-year-old girl with a collapsing lateral pillar C head that reframes the prognosis and the urgency.
Candidate brief
You are the general paediatric registrar in the orthopaedic clinic. You have eight minutes to answer the examiner's questions on the child below. The viva branches through diagnosis, investigation, classification, management, and then to a second scenario. Be prepared to justify each answer with the underlying pathophysiology and the relevant evidence. [1] [4]
References5ShowHide
- [1]Herring JA, Kim HT, Browne R, et al. Legg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome. Journal of Bone and Joint Surgery (American Volume), 2004.PMID 15466720
- [2]Wiig O, Terjesen T, Svenningsen S. Prognostic factors and outcome of treatment in Perthes' disease: a prospective study of 368 patients with five-year follow-up. Journal of Bone and Joint Surgery (British Volume), 2008.PMID 18827249
- [3]Terjesen T, Wiig O, Svenningsen S. The natural history of Perthes' disease. Acta Orthopaedica, 2010.PMID 21067434
- [4]Herring JA. Legg-Calve-Perthes disease at 100: a review of evidence-based treatment. Journal of Pediatric Orthopaedics, 2011.PMID 21857427
- [9]Huhnstock S, Wiig O, Merckoll E, et al. The modified Stulberg classification is a strong predictor of the radiological outcome 20 years after the diagnosis of Perthes' disease. The Bone and Joint Journal, 2021.PMID 34847712