The disease has four radiographic phases: 1 in the initial phase, there is cessation of growth at the capital femoral epiphysis, a smaller femoral head epiphysis, and widening of articular space on the affected side; 2 in the fragmentation phase, evidence of repair and new bone formation are represented by increased radiolucency within the femoral head epiphysis; 3 during reossification, normal bone density returns as the shape of the femoral head and neck are restored; 4 in the healed stage, there may be residual deformity from disease and the repair process, and gradual remodeling may take 2 to 4 years. The primary goals of treatment are to minimize hip irritation, preserve mobility, "contain" the femoral epiphysis within the confines of the acetabulum (ball and socket), and regain the natural spherical shape of the femoral head Surgical containment options include the tenotomy procedure, which may be performed to release shortened, atrophied muscles resulting from prolonged limping.
dximaging0808 7/29/08 10:50 AM Page 62 Diagnostic Imaging Review
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