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On a Particular Form of Pseudo-Coxalgia Associated with a Characteristic Deformity of the Upper End of the Femur

Calvé·Rev Chir·1910·10 citations·Pediatrics
DOI
SummaryAbstract on publisher site →

Calvé's 1910 case series describes 10 children with a distinct non-tuberculous hip arthritis. He defined its clinical and radiographic features: coxa vara, femoral head hypertrophy, and fragmentation of the epiphyseal center. The paper asks whether this entity, previously mistaken for hip tuberculosis, is a separate disease.

Study Snapshot

Design
Case series
Setting: Maritime Hospital, Berck-sur-mer, France
Objective
Whether a distinct non-tuberculous hip arthritis with femoral epiphyseal deformity exists in children
Outcome(s)
Clinical and radiographic characterization of the deformity and course
Subjects
10 children with hip arthritis
Inclusion
  • Children with chronic hip arthritis
  • Distinct clinical and radiographic pattern
Exclusion
  • Confirmed tuberculous coxalgia
Follow-up
Serial radiographs over evolution of lesion

Key Findings

  • Calvé observed 10 cases among more than 500 hip disease patients, all in children aged 3.5 to 10 years. The rarity and young age set this apart from the tuberculous coxalgia that dominated his hospital.
  • The radiographic hallmark was fragmentation, flattening, and atrophy of the femoral epiphyseal ossification center. The superior head surface was incompletely covered by bone, giving the condition its defining appearance.
  • Serial radiographs in 3 cases captured the natural history: the ossific center split into secondary centers, then the islands grew, approached, and reunited into a single mass. This documented reossification is the classic Perthes sequence.
  • The joint space stayed normal and Shenton's line was intact, with no bone or cartilage loss. This preservation is the key feature separating it from tuberculosis, which destroys bone and narrows the joint.
  • Coxa vara was constant, with a neck-shaft angle of 90 to 120 degrees and an elevated greater trochanter above the Nélaton-Roser line. The resulting gluteal insufficiency produced a Trendelenburg waddle.
  • The arthritis was self-limiting: pain and motion recovered rapidly, and no relapse occurred after walking resumed. This benign course contrasts with tuberculous arthritis, which Calvé notes lasts 2 to 3 years and recurs.
  • Mantoux testing in 5 cases (3 positive, 2 negative) plus absence of abscess and adenopathy let Calvé exclude hip tuberculosis as the cause.
Board PearlPreserved joint space with epiphyseal fragmentation in a child's hip points to Perthes, not tuberculosis.

Clinical Relevance

When a young child presents with a limp, knee pain, and limited hip abduction, the reflexive historical diagnosis was hip tuberculosis. Calvé's contribution was showing that a subset of these children had something entirely different. The decision rule he established still holds: preserved joint space and an intact Shenton's line point away from infection and toward an epiphyseal disorder.

This paper is one of the original descriptions of what became Legg-Calvé-Perthes disease, published the same year as Legg's and Perthes' accounts. For boards, anchor on the pattern: fragmentation of the femoral ossific nucleus with a normal joint space, followed by reossification, in a child aged 4 to 10.

Remember that referred knee pain and a Trendelenburg gait are classic, and that hip pathology must always be excluded in a child complaining of knee pain.

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|

On a Particular Form of Pseudo-Coxalgia Associated with a Characteristic Deformity of the Upper End of the Femur

Calvé·Rev Chir·1910·10 citations·Pediatrics
DOI
SummaryAbstract on publisher site →

Calvé's 1910 case series describes 10 children with a distinct non-tuberculous hip arthritis. He defined its clinical and radiographic features: coxa vara, femoral head hypertrophy, and fragmentation of the epiphyseal center. The paper asks whether this entity, previously mistaken for hip tuberculosis, is a separate disease.

Study Snapshot

Design
Case series
Setting: Maritime Hospital, Berck-sur-mer, France
Objective
Whether a distinct non-tuberculous hip arthritis with femoral epiphyseal deformity exists in children
Outcome(s)
Clinical and radiographic characterization of the deformity and course
Subjects
10 children with hip arthritis
Inclusion
  • Children with chronic hip arthritis
  • Distinct clinical and radiographic pattern
Exclusion
  • Confirmed tuberculous coxalgia
Follow-up
Serial radiographs over evolution of lesion

Key Findings

  • Calvé observed 10 cases among more than 500 hip disease patients, all in children aged 3.5 to 10 years. The rarity and young age set this apart from the tuberculous coxalgia that dominated his hospital.
  • The radiographic hallmark was fragmentation, flattening, and atrophy of the femoral epiphyseal ossification center. The superior head surface was incompletely covered by bone, giving the condition its defining appearance.
  • Serial radiographs in 3 cases captured the natural history: the ossific center split into secondary centers, then the islands grew, approached, and reunited into a single mass. This documented reossification is the classic Perthes sequence.
  • The joint space stayed normal and Shenton's line was intact, with no bone or cartilage loss. This preservation is the key feature separating it from tuberculosis, which destroys bone and narrows the joint.
  • Coxa vara was constant, with a neck-shaft angle of 90 to 120 degrees and an elevated greater trochanter above the Nélaton-Roser line. The resulting gluteal insufficiency produced a Trendelenburg waddle.
  • The arthritis was self-limiting: pain and motion recovered rapidly, and no relapse occurred after walking resumed. This benign course contrasts with tuberculous arthritis, which Calvé notes lasts 2 to 3 years and recurs.
  • Mantoux testing in 5 cases (3 positive, 2 negative) plus absence of abscess and adenopathy let Calvé exclude hip tuberculosis as the cause.
Board PearlPreserved joint space with epiphyseal fragmentation in a child's hip points to Perthes, not tuberculosis.

Clinical Relevance

When a young child presents with a limp, knee pain, and limited hip abduction, the reflexive historical diagnosis was hip tuberculosis. Calvé's contribution was showing that a subset of these children had something entirely different. The decision rule he established still holds: preserved joint space and an intact Shenton's line point away from infection and toward an epiphyseal disorder.

This paper is one of the original descriptions of what became Legg-Calvé-Perthes disease, published the same year as Legg's and Perthes' accounts. For boards, anchor on the pattern: fragmentation of the femoral ossific nucleus with a normal joint space, followed by reossification, in a child aged 4 to 10.

Remember that referred knee pain and a Trendelenburg gait are classic, and that hip pathology must always be excluded in a child complaining of knee pain.

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