It manifests itself with limping and limping in children’s walking. Early diagnosis is of great importance in the treatment of Perthes, which is 5 times more common in boys than in girls.
Risk Factors in Perthes Disease
Perthes disease occurs as a result of impaired blood circulation in the round head area at the top of the thigh bone called the femur. This disease, which occurs between the ages of 4 and 8, is seen in one of every 10,000 children. Perthes usually affects only one joint. Sometimes it occurs in both hips. In this case, it is necessary to be careful at the point of diagnosis, as it can be confused with other diseases. The cause of the disease is unknown. However, studies have revealed that the following predispositions pose a risk of developing Perthes, although the exact cause is unknown:
Attention deficit and hyperactivity problem
Countries with low socio-economic level
Perthes in family history
European and Asian breeds
Born with a low birth weight
Being in smoking environments (being a passive smoker)
Symptoms of Perthes Disease
Perthes; It manifests itself with symptoms such as pain in the thigh and hip, limping in the leg, and limping. These symptoms can sometimes be very mild or sometimes very severe. In very rare cases, shortening of the leg can also be seen. For this reason, in cases where a child frequently talks about pain and if there is a problem in walking, it is useful to consult a pediatric orthopedic specialist before it is too late.
Diagnostic Methods in Perthes Disease
In the disease, an x-ray film is taken along with the physical examination. In general, it is possible to diagnose the disease by X-ray. In the very early stages, the problem may not be noticed on the x-ray film. In this case, if the child’s pain does not go away, an x-ray should be taken for control purposes. Although there are cases where MR or scintigraphy is recommended by a pediatric orthopedist, x-ray film alone is usually sufficient.
Treatment of Perthes Disease
Treatment of Perthes disease varies according to the age of the patient and the degree of the disease. If the disease is diagnosed at an early stage, if the child’s bone age is less than 6 years old and if the joint movements are clear, the patient should be followed up by a pediatric orthopedist. In treatment, the child’s activities are limited. Although it is allowed to step on it and walk, it is not allowed to engage in sports activities. If the child’s pain increases, rest is recommended and the pain disappears at the end of this process.
The main goal in the treatment of Perthes disease is to preserve the range of motion of the joint. Thus, the development of the femoral (thigh) head in a spherical structure is ensured. Treatment of Perthes disease lasts until the child’s bone development is complete. After recovery, there is no problem in early adulthood. However, calcification can be seen in the hips in the 50s and 60s.
Perthes is seen in 4 stages. Patients usually encounter the first symptoms in the second stage and apply to the physician. During the transition from the third stage to the fourth stage, bone death occurs in some or all of the femoral head bone. The body creates new bone to replace dead tissue. The purpose of the treatment in the restructuring phase; is to keep the femoral head inside the socket part of the hip joint. For this purpose, some surgical operations are performed by pediatric orthopedists when deemed necessary. In some cases diagnosed late and noticed in advanced stages, treatment with observation and physical therapy protocol can be preferred and surgical treatments are prepared when the child grows up.