Legg, Boston Med Surg J 1910 - An Obscure Affection of the Hip Joint

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An Obscure Affection of the Hip Joint

Legg·Boston Med Surg J·1910·11 citations·Case series

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Legg reports five children with a previously unrecognized flattening of the femoral head. He asks whether this is a distinct condition and proposes a cause based on impaired blood supply to the head. This 1909 presentation is one of the three original descriptions that named Legg-Calvé-Perthes disease.

Key Findings

All five children fell into a tight age band of 5 to 8 years and presented with the same picture: a limp with femoral neck thickening but no pain, no shortening, and no constitutional symptoms. This consistency is what let Legg argue it was a distinct entity.
Radiographs showed the femoral head flattened and spread out with a shortened, thickened neck. This is the radiographic signature that still defines the disease on plain films today.
The head flattening was bilateral in 2 of 5 cases, and in both the second hip was completely asymptomatic. This foreshadowed the modern recognition that LCPD can be bilateral and clinically silent on one side.
Every case had a preceding fall or injury before the limp began. Legg used this to build his indirect-trauma hypothesis, though injury is not the accepted cause today.
The Von Pirquet tuberculin test was negative in tested cases, which mattered because tuberculous hip was the major differential for a limping child in 1910.
One case (Case V) had a staphylococcal infection of the femoral neck and was the only child with pain, which Legg treated as a separate secondary process rather than the core disease.

Board PearlLegg's 1910 report defined the painless childhood limp with a flattened femoral head now known as Legg-Calvé-Perthes disease.

An Obscure Affection of the Hip Joint

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|

An Obscure Affection of the Hip Joint

Legg·Boston Med Surg J·1910·11 citations·Case series

|

Legg reports five children with a previously unrecognized flattening of the femoral head. He asks whether this is a distinct condition and proposes a cause based on impaired blood supply to the head. This 1909 presentation is one of the three original descriptions that named Legg-Calvé-Perthes disease.

Key Findings

All five children fell into a tight age band of 5 to 8 years and presented with the same picture: a limp with femoral neck thickening but no pain, no shortening, and no constitutional symptoms. This consistency is what let Legg argue it was a distinct entity.
Radiographs showed the femoral head flattened and spread out with a shortened, thickened neck. This is the radiographic signature that still defines the disease on plain films today.
The head flattening was bilateral in 2 of 5 cases, and in both the second hip was completely asymptomatic. This foreshadowed the modern recognition that LCPD can be bilateral and clinically silent on one side.
Every case had a preceding fall or injury before the limp began. Legg used this to build his indirect-trauma hypothesis, though injury is not the accepted cause today.
The Von Pirquet tuberculin test was negative in tested cases, which mattered because tuberculous hip was the major differential for a limping child in 1910.
One case (Case V) had a staphylococcal infection of the femoral neck and was the only child with pain, which Legg treated as a separate secondary process rather than the core disease.

Board PearlLegg's 1910 report defined the painless childhood limp with a flattened femoral head now known as Legg-Calvé-Perthes disease.

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