see also: [[paediatric limp]] > - **segmental avascular necrosis of the femoral head** > - age range 5-10 usually > - 1/5 bilat **history** - well child with intermittent limp - may have hip, groin, or knee pain **exam** - reduced ROM - internal rotation and extension more painful - unequal leg lengths **Ix** - XR - initial increase in density of femoral head - followed by fragmentation, loss of contour - epiphyseal osteoporosis - loss of joint space ![[Pasted image 20240220162916.png]] ![[Pasted image 20240220164700.png]] ![[Pasted image 20240220164818.png]] **management** - *femoral osteotomy or bracing* - healing takes years