From previous experimental investigations of a model of
Legg-Calve-Perthes disease in young pigs, it was speculated that the early
radiographic phenomenon of the subchondral crescentic-shaped radiolucent
line is a pathological fracture and, furthermore, that this fracture
initiates the stage of resorption. Being painful, the fracture also heralds
the clinical onset of the disease. From these laboratory investigations,
plus a preliminary radiographic investigation in children, it has been
observed that only that portion of the epiphysis underlying the subchondral
fracture is resorbed. The radiographic investigation of 1,057 children
(1,264 involved hips) with Legg-Calve-Perthes disease from four
institutions included 376 hips in which the diagnosis had been made early
and the subchondral fracture was detectable. In all of these hips the
extent of the subchondral fracture correlated precisely with the subsequent
extent of maximum resorption. Consequently, in the early stage of
Legg-Calve-Perthes disease the extent of the subchondral fracture is of
prognostic significance in predicting the eventual extent of involvement of
the femoral head. We propose a simple and practical two-group
classification of the extent of involvement of the femoral head: Group A
(less than half of the head) and Group B (more than half of the head). The
classification can be applied in the early stage of the disease when the
subchondral fracture is detectable as well as throughout the ensuing
resorptive stage.