A 4-year-old boy is diagnosed with Legg-Calvé-Perthes (LCP) disease involving the entire femoral head (Catterall Group IV). According to the concept of 'containment', the surgical treatment that best reduces lateral extrusion of the femoral head is:
- A Varus derotation osteotomy (VDRO) of the proximal femur
- B Both VDRO or Salter osteotomy achieve similar containment ✓
- C Salter innominate osteotomy (acetabular redirection)
- D Chiari pelvic osteotomy for shelf augmentation
Explanation
In LCP disease, the goal of treatment is 'containment' — maintaining the spherical femoral head within the acetabulum so the acetabulum acts as a mold during the reossification phase, preventing lateral extrusion and producing a round, congruent femoral head. Containment can be achieved by either proximal femoral varus derotation osteotomy (VDRO — redirects the head into the acetabulum by varus angulation) or Salter innominate osteotomy (redirects the acetabulum anterolaterally to cover the head). Both are equivalent in outcomes for Catterall III–IV/Herring B–C (high-risk) hips; the choice depends on patient age, head morphology, and surgeon preference.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.