Classification in LCPD

IIPO
 Objectives
• Clinical features of LCPD?
• Classification of LCPD
• Prognosis
 Clinical Features
• Painless limp leads to painful limp

• Pain in the groin, anterior hip or greater trochanter

• Referred pain to the knee

• Combination of antalgic & trendelenburg gait.

• Decreased range of motion especially abduction and
internal rotation.

• Atrophy of thigh muscles.

• Shortening
 Classification

• Catterall classification

• Salter Thompson classification

• Stulberg classification
 Catterall Classification

● In 1971
● used radiological findings of epiphyseal
involvement to identify 4 groups
 Catterall classification

• I – only anterior portion of epiphysis affected.

• II – anterior segment involved central sequestrum present

• III – most of epiphysis sequestered with unaffected portions

located medial and lateral to central segment

• IV – all of epiphysis sequestered.

 Catterall classification
● Groups I and II had a good prognosis
(in 90%) and required no intervention.

● Groups III and IV had a poor prognosis

(in 90 %) and required treatment.
 Salter Thompson

● Extent of subchondral # in both AP & lateral xrays

● reliable indicator in the group with fractures

 Salter Thompson Type A

•Extent of the fracture (line) is less than 50% of the

superior dome of the femoral head › good results can be
expected.
 Salter Thompson Type B

Extent of the fracture is more than 50% of the dome,

fair or poor results can be expected
 Stulberg classification
• Class I – Shape of the femoral head was basically normal.

• Class II – Loss of head height but within 2 mm to a

concentric circle on AP X-Ray

• Class III – Deviates more than 2 mm and acetabulum

contour matches the head contour

• Class IV – Head Flattened, Flattened area <1cm.

Acetabulum contour matches the head contour

• Class V – Collapse of femoral head, Acetabular contour

does not change.
• Class I & II – Spherically congruent.

• Class III & IV – Congruous Incongruity

OR
Aspherical congruity.

• Class V – Incongruous incongruity

OR
Aspherically incongruent.
• Class I Shape of the
femoral head is
basically normal.
• Class II Loss
of head height
but within 2
mm
• Class III Deviates
more than 2 mm
• Class IV Head
Flattened
• Class V Collapse of
femoral head, Acetabular
contour does
not change
 Prognostic Factors
Age at diagnosis
<6 yrs – good
6 – 9 yrs – fair
>9 yrs - poor
 Classification of results
• CEA / angle of Weiberg.
 CE angle of Weiberg
• Indicator of acetabular
depth
• It is the angle formed by a
perpendicular line through
the midpoint of the femoral
head and a line from the
femoral head center to the
upper outer acetabular
margin.
• Normal = 20 to 40 degrees
• Angle >25 = good, 20-25=
fair, < 20 = poor
POLLING
 References
• Joseph B. Webster, Douglas P. Murphy. Atlas of orthoses and
assistive devices, 5th edition, chapter-31, p 318-321.
Thanks