CHAPTER 19

Perthes Disease

Introduction/Etiology/Epidemiology

• Perthes disease develops secondary to a disruption of blood supply to the proximal femoral epiphysis at the hip.

• It generally affects children between 4 and 9 years of age but can be seen in children as young as 2 or as old as 11 years.

• It is more common in males than in females (4–5:1).

• It is typically unilateral (85% of patients).

• Commonly seen in very active children

• Etiology is unknown; proposed mechanisms include minor trauma, exposure to secondhand smoke, hypercoagulability, environment, and heredity.

Signs and Symptoms

• Patients typically present with gradual onset of a limp or activity-related thigh or knee pain. Always consider hip etiology in a limping child with knee pain.

• Some patients report hip discomfort.

• Physical examination shows guarding at the extremes of hip range of motion, limited hip abduction and internal rotation, and antalgic gait.

• Some patients may have a hip flexion contracture.

Differential Diagnosis

• Transient synovitis of the hip

• Septic arthritis

• Developmental dysplasia of the hip

• Multiple epiphyseal dysplasia or other skeletal dysplasia

• Sickle cell disease

• Corticosteroid-induced osteonecrosis

• Juvenile idiopathic arthritis

• Slipped capital femoral epiphysis

• Muscle strain or apophysitis of pelvis should be considered in cases with acute onset during activity, especially in adolescents.

Diagnostic Considerations

• Perthes disease is a diagnosis of exclusion; diagnosis is established on radiographs.

— Obtain anteroposterior (AP) and frog lateral views of both hips.

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Miscellaneous Infections Nonaccidental Trauma Kyphosis Bone Health Evaluation in the Child Vulnerable to Fracture Compartment Syndrome The Limping Child: General Approach and Differential Diagnosis0

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