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Classification of Perthe's disease

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Classification of Perthe's disease

A fourfold classification of the condition in relation to extent of the involvement of the femoral head has been proposed by Catterall:

  • grades of involvement are as follows:
    • I - central involvement
    • II - central involvement with collapse
    • III - nearly whole head involvement
    • IV - whole head involvement

  • but the reliability and prognostic value is limited (1)
  • this classification was supplemented with “head at risk signs”
    • these were associated with a poorer prognosis
    • signs include:
      • Gage's sign - a radiolucent defect between the lateral epiphysis and metaphysis
      • calcification lateral to the epiphysis
      • metaphyseal cysts
      • lateral subluxation
      • horizontal growth plate (2)

An alternative classification based on the height of the lateral pillar of the epiphysis of the femoral head (as seen on an AP x-ray view) in the early fragmentation phase has been described by Herrring in 1992.

  • the three choices include:
    • the lateral pillar is intact
    • at least 50% of the lateral pillar remains standing
    • less than 50% of the lateral pillar remains standing (1)

  • this has a greater prognositic value and also a greater inter-observer reliability than the Catterall classification
  • predictive value is higher when the patient's age at the onset of the disease is also taken into consideration (1).

Reference:

  1. Nelitz M, Lippacher S, Krauspe R, Reichel H. Perthes Disease Current Principles of Diagnosis and Treatment Dtsch Arztebl Int. 2009 July; 106(31-32): 517–523.
  2. The Pediatric Orthopaedic Society of North America (POSNA) 2012. Legg-Calve-Perthes Syndrome

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