Perthes' Disease (3)

Question 1

What occurs here?

What is its main complication?

How does it present?

Answer 1

➊ Ischaemia of femoral head → Avascular Necrosis

➋ Soft and deformed femoral head → Early OA

➌ • Gradual hip pain
• Limp, worsened with activity
• Restricted ROM
• No hx of minor trauma – Differentiates it from SUFE, esp. in older children

Question 2

How is it investigated?

Answer 2

• XR – May be normal in early stages due to fragmentation and remodelling of proximal femoral epiphysis
• Bloods – CRP to exclude inflammatory causes of joint pain

Question 3

How is it managed?

Answer 3

• If < 50% of femoral head is involved – Conservative measures like rest, traction and crutches
• If > 50% of femoral head is involved – Plaster case or surgery
‣ This carries a higher risk of OA later in life
• Physiotherapy