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Legg-Perthes disease in a Down syndrome patient
Jong Sup ShimSamsung Medical Canter
Sungkyunkwan University School of Medicine
An 11 year-old female patient
• Painful limping for 2 months
• Can’t walk without assistance
• Has underlying Down syndrome
(Diagnosed at age 11 mo)
LCP disease in Down syndrome
Past Medical History
• She was diagnosed as Legg-Perthes disease at other university hospital.
• Operation was performed for LCP disease and hip subluxation by open reduction, varization, Salter operation and trochanteric apophysiodesis (at age 10yr 8 mo).
• After 2 months of Spica cast immobilization, then persistent hip dislocation was found.
LCP disease in Down syndrome
LCP disease in Down syndrome
•Re-Do open reduction (with tight capsular plication)•Chiari osteotomy
Postop cast immobilization for 6 weeks
Hip Joint in Down syndromeShaw ED, Beals RK, CORR,1992
LCP disease in Down syndrome
218 hips in 114 patients with Down syndrome(10- 43 years old)
11 hips(4.8%) in 9 Patients(7.9%) had some hip abnormality
Dysplasia (5)Dislocation (4)Avascular necrosis (1) – 15 yr old maleSlipped capital femoral epiphysis (1)
Hip Joint in Down syndromeShaw ED, Beals RK, CORR,1992
LCP disease in Down syndrome
218 hips in 114 patients with Down syndrome(10- 43 years old)
11 hips(4.8%) in 9 Patients(7.9%) had some hip abnormality
Dysplasia (5)Dislocation (4)Avascular necrosis (1) – 15 yr old maleSlipped capital femoral epiphysis (1)
Perthes disease/avascular necrosis in Down syndrome
LCP disease in Down syndrome
Lawhon et al, Contemp Orthop,1990
4/162
Makley and Sligar, Orthop Tran,1979
3/100
Treatment of severe late onset Perthes disease with soft tissue release and articulated hip distraction: early result Segev et al,JPO(B),2004
“In Down syndrome, results significantly inferior to those having only Perthes’ disease.”
LCP disease in Down syndrome