Perthes Flashcards
Define
Painful disorder of childhood characterized by avascular necrosis of femoral head in a growing child.
- male 4x
- 4-10 years old
Other names of perthes disease
- coxa plana
- osteochondritis deformans juvenilis
Etiology
- thrombophilia
- anti thrombotic factor deficiency
- low birth weight
- high birth order
- delayed bone age
Pathology
Stage 1: ischemia and bone death
Stage 2: revascularization and repair
Stage 3: distortion and remodeling
C/F
- limping exacerbated by activity
- painful: at groin, anterior hip, around trochanter and referred to knee
- hx of trauma may be present
Examination
- Look: normal looking hip with some wasting
- feel: irritable, tenderness in groin, scarpa’s triangle
- move: restricted and painful( abduction and internal rotation limited)
- gait: antalgic + trendelenburg gait
- shortening may be present
- caterall’s sign
Caterall sign
When hip is flexed it goes into obligatory external rotation and knee points towards axilla
Investigation
- x-ray
- bone scan
- MRI ✅
Radiological findings
- increase joint space
- asymmetry of ossific centre
- flattening and lateral displacement of epiphysis
- rarefaction and widening of metaphysis
- alternating density and lucency( fragmentation) in revascularization phase
D/D
- Morquio disease
- cretinism
- sickle cell anemia
- SLE
- radiation
- infection
- hypothyroidism
Management
Conservative
- pain control and traction
- gentle exercise and physiotherapy
Containment
- non surgical: orthopedic braces which causes abduction of hip
-surgical: varus derotation osteotomy of femur
: innominate and chiari osteotomy
Distal femoral epiphyseodesis in contralateral limb for limb length discrepancy
T/t acc to age
<6 yrs: symptomatic t/t and activity modification
6-8 yrs
Abduction brace
Osteotomy
9+
Osteotomy
Complications
- permanently deformed hip
- loss of movement
- limb length discrepancy
- degenerative disease like OA
