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Epidemiology
It occurs between about 18 months of age and skeletal maturity. Most children are between
5 and 10 years of age at the time of onset. It is bilateral in 10 to 12 % of children. Boys are
affected 4 to 5 time more frequently than girls. Girls have a worse prognosis.
Etiology
The cause is uncertain. It is probably multifactorial. Haematologic and clotting
abnormalities (e.g. deficiencies of protein C and S) have been suggested by some but have
not been confirmed by others.
The main arterial supply to the femoral head comes from the lateral ascending cervical
artery which is the terminal branch of the medial circumflex femoral artery and lies within
the hip joint capsule. The terminal branch runs through a narrow passage between the
greater trochanter and the capsule where it can become constricted. The blood supply can
be occuled by abducting and internally rotating the hip.
Very narrow lateral pillar (2-3 mm wide) with 50% of the original height that is depressed
relative to the central pillar.
Group C
Lateral pillar with <50% of the original height
It has superseded the classification and has become the most commonly used classification.
Treatment
This is very controvesial with there being no national and no international agreement.
In the early onset group under the age of the 8 years, children are mostly managed nonoperatively.
Prognosis
This is related to the congruency of the hip joint and the spericity of the femoral head.
CAVES : CavusAdductusVarusEquinus
The forefoot looks supinated but it is in a pronated position in relation to the midfoot. The
calf and foot are smaller which is obvious in the unilateral deformity.
Each component scores 0,05 or 1 giving a maximum of 6 points for the most severe
deformity.