Waldenström classification of Perthes disease

Last revised by Andrew Murphy on 31 Jul 2022

Citation, DOI, disclosures and article data

Citation:

Gaillard F, Lukies M, Rasuli B, et al. Waldenström classification of Perthes disease. Reference article, Radiopaedia.org (Accessed on 25 Apr 2024) https://doi.org/10.53347/rID-7224

DOI:

https://doi.org/10.53347/rID-7224

Permalink:

https://radiopaedia.org/articles/7224

rID:

7224

Article created:

18 Sep 2009, Frank Gaillard ◉ ◈

Disclosures:

At the time the article was created Frank Gaillard had no recorded disclosures.

View Frank Gaillard's current disclosures

Last revised:

31 Jul 2022, Andrew Murphy ◉

Disclosures:

At the time the article was last revised Andrew Murphy had no financial relationships to ineligible companies to disclose.

View Andrew Murphy's current disclosures

Revisions:

16 times, by 10 contributors - see full revision history and disclosures

Systems:

Musculoskeletal, Paediatrics

Sections:

Staging, Classifications

Tags:

hip, refs

The Waldenström classification of Perthes disease refers to x-ray abnormalities and represents four temporal phases of the disease. These stages have been further subdivided in the modified Elizabethtown classification ².

stage I: early
- asymmetric femoral epiphyseal size (smaller on the affected side)
- apparent increased density of the femoral head epiphysis
- widening of the medial joint space
- blurring of the physeal plate
- radiolucency of the proximal metaphysis
stage II: fragmentation
- subchondral lucency (crescent sign)
- femoral epiphysis fragments
- femoral head outline is difficult to make out
- mottled density
- thickened trabeculae
stage III: reparative
- re-ossification begins
- shape of the femoral head becomes better defined
- bone density begins to return
stage IV: healed
- depending on the severity, the femoral head may be nearly normal or may demonstrate:
  - flattening of the articular surface, especially superiorly
  - widening of the head and neck of the femur

History and etymology

The staging system originally described by J H Waldenström in 1922 had some differences in numbering (IA: initial stage, IB: fragmentation stage, II: healing period, III: growing period, IV: definite stage) ⁴. What is today widely known as Waldenström classification is probably better reflecting the classification used by S T Canale in 1972 ⁵ and is therefore called Elizabethtown classification by some ².