الفهرس 
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Abstract
Legg Calve Perthes disease (LCPD) is defined as an idiopathic osteonecrosis of the femoral head which leads to variable complications with resultant deformity of the femoral head and, later, osteoarthritis. Unlike normal, healthy bone, the bone of the avascular epiphysis is not capable of withstanding the stresses on the epiphysis of the femoral head in cases of LCPD. The aim of treating Perthes disease is to reduce the risk of later osteoarthritis by preventing femoral head deformity, which may occur if adequate containment is not achieved.
there are many methods of treating Legg Calve Perthes disease, including operative and nonoperative methods. Femoral varus osteotomy is one of the surgical methods used to treat this disease, and it involves changing the alignment of the proximal femur to improve containment of the femoral epiphysis in the acetabulum.
The aims of this study were to evaluate the results of femoral varus osteotomy for the treatment of Perthes dis-ease according to various classification and grading schemes, as well as to compare the results to those obtained using other methods of treatment reported in the literature.
Containment is an attempt to reduce the forces through the hip joint by actual or relative varus positioning. Containment may be achieved by nonoperative or operative methods. The general acceptation is that treatment is not indicated in all cases in Catterall group I and in most of those in Catterall group II in children under seven years of age. Patients in group II who are eight years of age or older and all those in Catterall group III and IV require treatment in order to obtain a satisfactory hip. Many investigators have advocated surgical methods for providing or maintaining containment. Surgical containment methods offer the advantage of early mobilization and avoidance of prolonged bracing or cast treatment.
Surgical treatment realigns the bony structures so that the head of the femur is placed deep within the acetabulum. Fixation is maintained with screws and plates that will be removed at a later date. In some cases, the socket must also be deepened because the ball actually has enlarged during the healing process and no longer fits snugly within. After either procedure, the child is often placed in a cast from the chest to the toes for 6 to 8 weeks. After the cast is removed the child will participate in physical therapy with protected weight bearing of the affected leg until X-rays reveal the final stages of the healing are under way.
In Zagazig university hospital twelve patients with Legg Calve Perthes disease were treated using a proximal femoral varus osteotomy procedure. The mean age of the patients was 7 years (range: 5–10 years). The average follow-up was 12 months (range: 6–24 months). Results The patients were classified and graded according to the Catterall and salter classifications. The preoperative and postoperative mean epiphyseal extrusion indices were as Significantly decrease from 16.08±2.23 to 8.41±1.56. The preoperative and the postoperative mean Wiberg’s CE angle were Significantly increase from 19.66±2.46 to 35.08±3.11. The preoperative and postoperative neck shaft angel mean was as significantly decrease from 146.33±6.31 to 120.66±4.65. Changes in clinical Harris hip scores were as follows Harris significantly increase from 64.08±4.64 to 85.16±2.65. In the last follow-up, the mean limb length discrepancy was 1cm of shortening on the operated side was improved after 12 months. In present study did not see any progressive change in this parameter during the follow-up period, all of the osteotomies united within 3 months without loss of fixation. Only one cases was got infection, and one case subcutaneous hematoma.
We were finding in this study and other different studies that proximal varus osteotomy is a reliable treatment in patients without advanced deformation or flattening of femoral head and in those with good containment in abduction and internal rotation especially if they are in-between 5-10 years of age. For older patients and for those with advanced deformity of the femoral head the results are not satisfactory.