Management of Perthes’ disease

Abstract

The main complication of Perthes’ disease is femoral head deformation. Evidence from the literature highlights two important factors related to the cause and timing of this complication. (1) Extrusion of the femoral head appears to be a major factor that leads to femoral head deformation. (2) Deformation of the femoral head occurs in the latter part of the stage of fragmentation. The likelihood of preventing femoral head deformation is over 16 times higher if extrusion is reversed or prevented by the early stage of fragmentation than if done later. Several treatment options have been described in children who present later in the course of the disease but the outcomes of all these measures do not compare with those of early intervention.

Osteochondroses

“…In those which fail conservative treatment, or are high risk (typically if greater than 20% of the femoral head is extruded) then surgical treatment should be considered to prevent irreversible femoral head deformation by point loading on the acetabular margin. 10,11 This can be done by a performing a proximal femur varus osteotomy, or corrective osteotomies of the acetabulum to cover the femoral head, such as a Salter osteotomy, triple innominate osteotomy, or by creating a bony shelf over the extruded femoral head. 10 Joseph et al stress the importance of recognizing extrusion early and correcting with surgery.…”

“…10,11 This can be done by a performing a proximal femur varus osteotomy, or corrective osteotomies of the acetabulum to cover the femoral head, such as a Salter osteotomy, triple innominate osteotomy, or by creating a bony shelf over the extruded femoral head. 10 Joseph et al stress the importance of recognizing extrusion early and correcting with surgery. They demonstrated an odds ratio of 16.58 of avoiding femoral head deformation if treated early.…”

“…Specific management depends on the severity of femoral head collapse, how much is covered within the acetabulum and the age of the child. 10 Several classification systems are used but we use Herring's pillar system, which is based upon the percentage collapse of the lateral pillar in the femoral head. The greater the collapse the worse the outcome.…”

Degenerative hip disorders in children

“…Хирургическое лечение БЛКП включает в себя несколько направлений в зависимости от стадии болезни и выраженности патогенетических механизмов. Ретроспективное значение имеют так называемые декомпрессионные операции (различные по исполнению остеоперфорации), с помощью которых возможно ликвидировать венозное полнокровие в головке бедра [39], а также костно-пластические вмешательства (аутои алло пластика дефекта), благодаря которым удается сохранить и ремоделировать головку бедра, ликвидировать очаг некроза. Исключение данных операций из основной лечебной тактики БЛКП связано с рядом факторов: малой эффективно- Ортопедия, травматология и восстановительная хирургия детского возраста.…”

Legg-Calvé-Perthes hastalığında pelvik osteotomiler

“…Tedavisiz takip edilen hastaların çoğunda fonksiyonel olarak iyi sonuç bildirilse de, hastalığın doğal seyri ve hastaya özgü prognostik etmenler göz önünde bulundurularak uygun müdahale-nin yapılması, erişkin dönemde dejeneratif koksartroz gelişiminden korunma sağlayabilir. [1][2][3][4][5][6] Her ne kadar kesin olarak tanımlanmamış olsa da, %80'in üzerindeki örtünme miktarının femur başı lateral taşmayı ve kompresyonunu engellediği kabul edilir. Pelvik osteotomiye geçmeden önce, femur proksimali normal biyomekaniği tesis edilebilir.…”