Children are prone to several rare orthopedic conditions that could become complicated if timely & proper treatment is not provided. One such rare condition is Perthes disease that affects children, especially at the age group of 4 to 10 years. This condition primarily affects the hips and the reason is a temporary disruption of blood supply to the head of the femur.
The femoral head is rounded and is the ball part of the "ball and socket" joint of the hip. When it comes to the treatment of Perthes disease, the aim is to maintain the rounded shape of the head of the femur as much as possible. The best thing here is that the long-term prognosis of this condition is good as after around 18 to 24 months of treatment, children can return to normal daily activities without any major complications. Non-surgical treatment is often preferred for this condition while surgery using Orthopedic Implants and Instruments is required in severe cases.
Some studies have indicated that Perthes disease is 5 times more common in boys than girls, but this fact can also be denied that in girls, this condition could be more severe than boys. Perthes disease could affect either one or both hips whereas, it is noticed that around 10-15% of all cases reported have both hips affected.
The four stages of Perthes disease include:
Initial Stage
This is the starting stage of Perthes disease where the blood supply is disrupted to the femoral head resulting in cell destruction. The inflammation and irritation will be noticed whereas, the child might show symptoms like limping or abnormal way of walking. This stage may last for several months.
Fragmentation
This is the phase where the chances of the collapse of the femoral head are high. The dead bone below the articular cartilage is removed and replaced quickly with softer bone during the fragmentation stage of Perthes disease.
Reossification
This is known to be one of the longest stages of Perthes disease and it could last for a couple of years. During this stage, the new and strong bone starts to develop while taking the shape of the femoral head.
Healing
This is the stage where the shape of the femoral head is almost achieved and the bone re-growth is complete. Here, a point to remember is that the perfectness of the femoral shape will depend upon several factors like the extent of damage that occurred during the second stage of this disease and the age of the child when the disease occurred.
Physical examination and x-ray can diagnose this condition easily. While on the other hand, some cases might require MRI, ultrasound, and blood examination as well.
The treatment procedure of Perthes disease will vary depending upon the age of the child, degree of deformity of the femoral head, and the stage at which it is diagnosed. While some of the common treatment methods that would be implemented include:
Regular physical and x-ray examination by the doctor
Prescribed anti-inflammatory medications to relieve pain and inflammation of the hip joint
Limiting high-impact activities like jumping and running to relieve pain and protect the femoral head
Physical therapy including strengthening exercises under the guidance of an experienced physiotherapist
Casting or bracing (to keep the femoral head in normal position if an x-ray or other tests show deformity development)
Surgery is not commonly done, and it is preferred when more than 50% of the femoral head is affected and when the child is above 8 years when the condition is diagnosed
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