Perthes disease Flashcards
Look/ inspection
antalgic gait
leg length discrepancy is a late sign
feel
nil of note
active and passive movement
pain limited ROM of L hip
most likely abduction and medial rotation
resisted movement
nil of note
trendelenberg test
positive
but is a late sign
hx
8 yr M, painless limp for past 3 wks, complaining of intermittent left hip and groin pain. No hx of trauma and PMHx of ADHD
DDx
perthes disease SUFE septic arthritis transient synovitis of hip haematological malignancy
Why is Perthes likely?
M:F ratio = 5:1
classic presentation painless limp initially
33% a/w ADHD
Why is SUFE unlikely?
SUFE pts tend to be older and overweight.
NHx no of months prior to presentation
Why is Septic arthritis unlikely?
more acute presentation fever & Hx of child with sudden pain w/ passive motion and unable to walk/use limb. Use Kocher score
Why is Transient synovitiss unlikely?
acute onset hip pain, unwilling to use hip, usually 4-8 yrs old.
Hx of recent viral infection/trauma
Why is haematological malignancy unlikely?
any child with limp needs a full blood count
investigations
X-ray AP Pelvis + frog leg lateral views
MRI
X-ray AP Pelvis + frog leg lateral views details
medial joint space widening
irregularity of femoral head ossification
crescent sign/ subchondral fracture
GP management
refer to ED –> Ortho
