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Perthes disease ( also call Legg - Calve - Perthes ) affects the child ’s pelvic arch and destroys part of the femoral head.1The body can entirely renew this bone or do it only partly and cause a permanent deformity .
It occurs in children between 3 and 12 eld and seem more frequently in boys ( 80 % ) than in girl ( 20 % ) . In most cases , it affects only one hip , but in 10 % of patient role the lesion fall out on both sides , although in these cases it usually does not seem at the same time .
How Is Perthes Disease Diagnosed?
Laboratory test for Perthes disease show no appreciable changes , the parentage counting is usually normal and there can only be a distinct increment in the charge per unit of deposit and speed of light - reactive protein .
ceremonious Radiology : Radiographic epitome are the most usual method to start the study of a dreadful rose hip or pelvis , on suspicion of Perthes disease or another nosological entity , as it is a simple method acting to accomplish , cheap and comparatively well-situated to interpret.2
With the clinical and radiological suspicion of Perthes disease , the bailiwick should be completed with more complex examen that a specializer in orthopaedics should call for , since they are outside the scope of primary care . These will allow establishing a therapeutic scheme . Among these technique are the chase :
sonography : Useful in the initial assessment of the process and to assess whether or not there is synovitis .
Gammagraphy with technetium-99 : It allows an early diagnosis of Perthes disease before radiological changes appear . It is also able to value the degree of revascularization of the femoral head during the evolutionary process .
Magnetic resonance : Like scintigraphy , it allows early diagnosis of the process , that is , before conventional skiagraphy shows alterations , with the reward that it provides crucial selective information about the shape of the forefront and the cotyloid cavity and the degree of congruence between them .
Arthrography : It is very utilitarian for visual image of the configuration of the femoral top dog and especially its relation to the acetabulum.3It allows the orthopedic surgeon to shew the operative strategy . It ’s main indication is in the diagnosis and judgment of the hip “ in a hinge . ”
Computed tomography – It is not used consistently , although it may be useful in the study of the extent of pearl involvement and the three - dimensional social organization of the hip .
With a well - performed medical chronicle , a heedful physical examen and hip x - shaft of light are ordinarily sufficient to make an initial diagnosis of Perthes disease in main guardianship .
However , in the initial phase of the Perthes disease , the differential diagnosing should be made with hip synovitis and septic arthritis in which the initial symptom are usually very standardised .
Normally Perthes disease is not related to Fall or blow in the hip , although it is common for parents to have a problem in their hips or that tike take corticosteroid medication for other diseases , are weighty or have had a menstruum of rapid growing .
For some reason that doctors do not know , there is not enough stemma flowing to the femoral school principal in Perthes disease . When this happen , some part of the bone dice ( this is call necrosis ) becoming more fragile and allowing the femoral head to be crushed .
The body will attempt to wipe out the dead bone and originate a process of re-formation in the femoral head . The whole cognitive process can last several years during which there may be inflammation and consequently pain or lameness . According to the capacity of re-formation of the torso , the femoral head will recover or not in full recuperate its globose shape .
Usually , the shaver with Perthes disease refers little or no pain sensation . If there is pain , it usually manifests at the level of the inguen but is often concern to in the thigh or knee .
It is frequent , however , that parent notice certain lameness , especially in the good afternoon or dark , when the kid with Perthes disease is shopworn .
Finally , there may be a decrement in hip mobility with discrete limitation to execute some activities . In these guinea pig , some atrophy of the thigh muscle may even seem .
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