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Modified Waldenstrom's Staging System of Van Dam et al for Legg-Calve-Perthes Disease

Description

van Dam et al used a modification of Waldenstrom's system to stage the radiographic changes in patients with Legg-Calve-Perthes Disease. This can be used to specify the chronological stage of the epiphysis at the time of a radiographic examination. The authors are from the US Army Medical Corps, New York University Hospital and the Shriners Hospital for Crippled Children in San Francisco.


 

NOTE: The authors found that the Catterall classification for the affected femoral head was likely to change if classification occurred prior to the fragmentation stage. They recommended that Catterall classification should not be done until after fragmentation of the capital epiphysis has occurred.

Description

Modified

Original Waldenstrom

no change

1

Ia

irregular contour and/or lucency of the epiphysis

2

 

decreased height and increased density of the epiphysis

3a

 

decreased height and increased density of the epiphysis, with irregular mineralization

3b

 

fragmentation of the epiphysis

4

Ib

early healing

5

II

late healing

6

 

femoral head healed with epiphysis still open

7

III

epiphysis closed (adult stage)

8

IV

 

where:

• Stage 2 may be accompanied by an increase in the medial cartilaginous joint space.

• early healing: amorphous, new enchondral bone formation

• late healing : trabecular bone replacing amorphous bone

 


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