pathology: perthes disease

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Perthes‘ disease ( Perthes-Calve-Legg disease, osteochondropathia deformans coxae juvenilis)

Definition

aseptic necrosis of the femoral head; the most common aseptic bone necrosis. Mostly occurs in children, peak age approx. 4-6 years. Boys are affected 4 times more frequently; affects both femoral heads in 1/3 of cases. The disease progresses in several stages, which can only be distinguished radiographically. The necrosis leads to joint effusion and impaired growth of the femoral head. The healed necrosis can result in a normal femoral head or a deformed, dysfunctional one.

At the time when Perthes‘ disease manifests itself, there is usually no sporting activity. Therefore, the condition after this time is decisive for the tolerance of sport, as deformations of the hip joint, the femoral head or incongruities can occur and lead to lasting, irreversible disorders. Radiological checks must be carried out repeatedly until growth is complete.

ICD M91

Cause

  1. unknown
  2. probably genetic or caused by trauma: An artery runs in a ligament holding the femoral head (straight into the femoral head), which possibly suffers a compression trauma; hormonal imbalance during the growth period is also thought to be the cause

Diagnosis

  1. Radiologically too wide joint space and other abnormalities
  2. Tests and signs: 4-sign (Patrik/Faber) test

Symptoms

  1. Leading symptom: Limping (which is otherwise very rare in children)
  2. Pain in the hip and knee, especially with rotation and abduction in the hip joint

Complications

  1. Hip osteoarthritis

Therapy

  1. Without therapy, the late consequence is usually coxarthrosis
  2. Previously mainly conservative: consistent long-term relief and immobilization with a Thomas splint. In addition, passive KG of the affected hip. Success: 50%, the remaining 50% received a new hip jointarthrosis. Further orthoses and splints available today
  3. Nowadays more frequently surgical: a wedge-shaped piece is removed from the femur (below the epiphyseal groove), which reduces the angle between the stem and the cup, so that the femoral head is better centered in the cup and the restoration is better.
  4. Swimming