Definition

Trauma1950s Congenital CDH Cytotoxic agents Growth related systemic abnormalities Transient synovitis1-3% Extracapsular arterial ring Ascending cervical vessels Retinacular brunches The artery of the ligamentum teres

Medial femoral circumflex Lateral femoral circumflex Extra capsular ring Lat ascending brunch Ant. Ascending brunch Post.ascendig Br. Med. Ascending Br. Lig Tres Sup.&Inf. Gluteal Ar. Subsynovial arterial ring Intracapsular ring Ant. Retinacular Ar. Inf. Metaphysial Ar. Post.Sup.Ret.Ar. Post.Inf.Ret.Ar. Lat.Epiphysial Ar. Sup. Metaphysial Ar.

6 Mo 4Yr. 7 Yr.

Physical examination Abduction Medial rotation Limited Synovitis Deformity ThighCalfButtock Long standing Head collapse R/O

Stage I a :Part or whole of the epiphysis is sclerotic with no collapse

Stage I b: Sclerosis & Collapse Herring

Stage II a : Early fragmentation; One or two vertical fissure

Salter: extent

Stage II b : Advanced fragmentation

Stage III a : Early new bone formation Voven bone less than 1/3

Stage III b : New bone more than 1/3 with normal texture

Each patient must be assessed : Loss of motion Joint contracture Pain A.P & Frog leg Lat. Stage The extent of involvement At risk signs

No at risk signs Catterall Group 1,2 Salter – Thompson Type A Herring Type A Already in the reossification stage

Head at risk signs Catterall 1971 Gage Calcification lat. To the epiphysis Lat. displacement Ex. Metaphysial changes Horizontal growth plate or

5 6 8 yr Mo