Meyer dysplasia in the differential diagnosis of hip disease in young children

Perthes disease in a 2-year-old child

Perthes disease represents a transient interruption of the blood supply to the femoral head followed by collapse and subsequent remodelling. The majority of cases present between the ages of 4 and 10 years. We report the case of a child who developed a painful right-sided limp some days after his second birthday. The limp was initially interpreted as a transient synovitis of the hip. However, when the limp persisted, further investigations revealed that he had Perthes disease.

Legg-Calve-Perthes disease in two generations of male family members: a case report

Legg-Calve-Perthes disease (LCPD) is a type of avascular necrosis of the femoral head occurring mainly in male children and causing early osteoarthritis. We report 2 generations of 4 male family members with LCPD-like features and mutation of the COL2A1 gene of the 12q13 chromosome. If LCPD occurs in any family member, we recommend genetic analysis and counselling as well as early radiological screening of related children.

Microcephaly associated with Legg-Calvè-Perthes disease in two siblings

The co-occurrence of microcephaly and Legg-Calvè-Perthes disease (LCPD) in members of the same family has been previously recorded only in two Hungarian brothers. To study the clinical and radiological phenotype in a (second) family with LCPD and microcephaly, clinical, X-ray and MRI follow-up study of two Albanian siblings aged 8 and 11 years, were made. Both siblings had primary microcephaly, seizures and mild-to-moderate mental retardation. At head imaging the boy was found to have skull asymmetry, partial lack of frontal lobe development and partial agenesis of corpus callosum and the girl had a complex brain malformation consisting in thickening of the fronto-temporal cortex, colpocephaly, increased curvature of the Sylvian fissure, elevated tentorium with mild hypoplasia of the cerebellar vermis and dilated cisterna magna. In addition, the brother had ADHD and the sister minor eye anomalies mainly consisting in epicanthic folds and pale bilateral (temporal) optic disk. We recorded (and documented for the first time by brain MRI) a second family with familial co-occurrence of LCPD and microcephaly and the first occurrence of complex brain anomalies in the context of a small head circumference. The present report could encourage the observation of similar cases.

Comparison of bone age delay and recovery in Meyer dysplasia and Legg-Calvé-Perthes disease: a pilot study

BACKGROUND

Meyer dysplasia (MD) is a rare disease but readily mistaken for Legg-Calvé-Perthes disease (LCPD). Although most published studies on MD have characterized and differentiated it from LCPD radiologically and clinically, differences with regard to bone age delay and recovery have not been sought. We deemed it necessary to distinguish bone age delay and recovery patterns between the two entities for better differentiation, prognostication, and parental advice.

METHODS

Bone age delay and recovery of eight patients who were initially diagnosed with LCPD but were found to have MD were retrospectively reviewed and compared with those of age-matched patients with LCPD. Based on hand radiographs, the radius-ulna-short bones (RUSs) and carpal bone ages were determined using the Tanner and Whitehouse 3 (TW3) method. Minimum follow-up was 2 years (range 2-5 years). Differences in RUS and carpal bone ages and recovery patterns between the two entities were analyzed using trend lines in scatter plots.

RESULTS

The mean delay of RUS bone age was significantly less in MD (0.52 ± 0.87 years) than in LCPD (1.11 ± 0.99 years). However, the difference between the mean carpal bone age delay in MD (1.13 ± 1.28 years) and LCPD (1.47 ± 1.19 years) was not significant. Trend lines showed faster bone age recovery patterns in MD than in LCPD.

CONCLUSIONS

Bone age was delayed in both MD and LCPD but was less delayed in the former. RUS bone age showed more significant differences than carpal bone age when comparing the two entities and hence might be more useful for differentiating the two. Earlier bone age recovery patterns may be anticipated in patients with MD.

Dysplasia epiphysealis capitis femoris: Meyer dysplasia

The clinical importance of dysplasia epiphysealis capitis femoris (Meyer dysplasia) is that it is easily mistaken for Legg-Calve-Perthes disease, leading to unnecessary diagnostic procedures and treatments. After a review of 578 children (619 hips) with Legg-Calve-Perthes disease, 17 children (27 hips) in whom both the clinical and radiologic pattern was obviously different could be found and a diagnosis of dysplasia epiphysealis capitis femoris was finally made. The mean age was 2.5 (range 1.9-3.6) years. There were 16 boys and 1 girl. Ten children had bilateral involvement (59%). The capital femoral epiphysis was delayed or was smaller in 26 hips, separated or cracked in 15, and cystic in 6. A normal bone structure was established in approximately 2 to 4 years. The final results assessed by the Mose and the Stulberg classification were good in all 27 hips. This study suggests guidelines for evaluating this rare condition based on the authors' findings and a review of the literature.