2. BLOOD SUPPLY TO THE FEMORAL HEAD:
At birth:
Vessels from lateral side: lateral epiphyseal artery
No ligamentum teres
3. 4 MONTHS TO 4 YEARS:
Epiphyseal ossification begins.
Ascending cervical branches.( metaphyseal and
lateral epiphyseal vessels)
After 4 months metaphyseal branches decrease.
4. 4 TO 7 YEARS
Epiphyseal plate is firm barrier between epiphysis
and metaphysis.
Only source is lateral epiphyseal arteries
9-10 YEARS
Ligamentum teres vessels becomes prominent.
Anastomose with lateral epiphyseal vessels.
5. ADOLESCENT PERIOD:
Growth plate extends beneath both epiphysis
EXTRACAPSULAR ARTERIEAL RING
ASCENDING CERVICAL BRANCHES
(retinacular arteries )
ARTERY OF LIGAMENTUM TERES
EPIPHYSEAL BLOOD SUPPLY
METAPHYSEAL BLOOD SUPPLY
6.
7.
8. VASCULAR SUPPLY
INCREASED INTRA-ARTICULAR PRESSURE
INTRAOSSEOUS PRESSURE
venous drainage in the femoral head is impaired, causing
an increase in intraosseous pressure
COAGULATION DISORDER
- Increase in serum levels of lipoproteins,thrombogenic
substance
9. SOCIAL CONDITIONS
- Usually belong to lower socioeconomic status, reflects
dietary and environmental factors
TRAUMA
. GENETIC FACTORS
- Inheritance 2-20%;
10. perthes disease may be defined as the “disease
of the hip, limited sharply by age group and
largely by sex, it results from changes in capital
femoral epiphysis, apparently secondary to loss
of an adequate blood supply for at least a
portion of head.”
Age group: 3-10 years
Sex: males 4-5 times more than girls
Bilateral in 10-12% of patients
11. 1) Incipient stage or
synovitis stage:
- Lasts for 1-3 weeks
- Synovium hyperaemic,
swollen
12. 2) Stage of avascular
necrosis:
- Dead trabecular bone
- Collapsed trabeculae
- Thickened articular
cartilage Physeal
disruption
- Cartilage extending
from the physis into the
metaphysis
13. 3) Fragmentation stage
Invasion of vascular granulation tissue
- New bone forming on old trabeculae
4) HEALING STAGE
- Normal forming bone alongside replacing
slowly resorbing bone.
- New bone, woven and lamellar
- Mushroom shaped contour.
- Soft tissues fibrotic, motion restricted.
- Return to normal architecture
