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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