perthes

Question 1

Perthes - boss study findings

Answer 1

poor prognosis
> 6
> girl

think trixie

Question 2

perthes treatment

Answer 2

• dynamic containment
• surgical containment

**Surgical options **
proximal varus osteotomy
salter osteotomy
- ilium to sciatic notch
- hinge on PS
- improves anterolateral coverage

risk of hinge abduction
- do a valgus osteotomy

Question 3

waldenstrom stages

Answer 3

initial
fragmentation
reossficiation
remodelling

Question 4

herring classifcation

Answer 4

lateral pillar classifcation
* A - lateral pillar full height
* B - >50% height maintained
* B/C - 50% of height maintained
* C -< 50% height maintained

controversy - diagnosis made in fragmentation stage - too late

Question 5

salter-thompson

Answer 5

• crescent sign < 1/2 femoral head
• crescent sign >1/2 femoral head

Question 6

early perthes findings

Answer 6

cresent sign
widening of medial joint space
decreased femoral head ossification centre

Question 7

perthes risk factors

Answer 7

• second hand smoke
• family hx
• low birth weight
• asian, inuit and central european decent

Question 8

perthes signs

Answer 8

• loss or IR and abduction
• trendelenberg gait - collapse of femoral head
• intermittent hip/ knee/ groin pain
• LLD - late
• adduction contracture - worsens apparent lld

Question 9

perthes - poor progrognosis

Answer 9

• adduction contracture
• catterall head at risk signs
• > 6yrs
• female
• heavy patient