A childhood illness, during which both use the medicine, as well as support from parents is positively influenced.

Definition – What is Perthes disease?

In the orthopedic children Perthes disease, which was discovered in 1910 by German surgeon Georg Clemens Perthes are usually benign growth disorders running of the femoral head. The symptoms can occur in one or both sides. Because the present circulatory disorder is in order, a femoral head (partial bone death) is possible, which can lead to collapse of parts of the femoral head.

Prevalence / incidence

The disease occurs in children between the second and tenth year at about one in 1,200 children. Boys are affected four times more frequently than girls. The disease has an annual incidence of five cases per 100,000 inhabitants is relatively common.

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Cause

The main cause of Perthes’ disease is a circulatory disorder (ischemia) and death (necrosis) of bone tissue assumed the femoral head. There are other theories, such as hormonal dysregulation, increased pressure in the bone or joint space as well as genetic factors, the overall cause is unknown.

The clinical picture

In the typical age of Perthes’ disease, between five and seven years, children usually develop a nonspecific limping. Knee pain and hip rotation restrictions may subsequently develop it. Not all patients have little pain, ¼ of the patients reported no pain, only ¼ of the knee and thigh pain.

The early stage of this disease is similar to a rheumatic disease, it leads to joint irritation with joint effusions. At a later stage become a permanent deformation of the head and pan, a movement disorder is the result. The early wear of the hip joint is inevitable.

Diagnosis

After the first, yet non-specific symptoms, is a clinical examination of the hip joint. The so-called 4-character, so the restriction of abduction and external rotation of the hip joint due to swelling of the skin or by a sense of joint effusion, is a typical sign of Perthes’ disease.

Blood tests, X-ray or ultrasound images and, if a magnetic resonance methods are further steps to arrive at a meaningful diagnosis and classification of the stages of the disease in the course and severity of prognosis.

Course of Perthes disease

Five stages describe the history of Perthes’ disease:

First The Inititalstadium, which is mainly characterized by edema in the bone and an accompanying inflammation of the joint capsule.
Second The condensation stage, where a compression of the affected bone occurs.
Third The Fragmentationsstadium by collapse of the femoral head or any part of the femoral head.
4th The Reparationsstadium where there is a reconstruction of the femoral head or to a annealing in a deformed position.
5th The Ausheilungsstadium by the conversion processes are completed. Perhaps then there is a deformity of the femoral head when it comes to the Reparationsstadium strain.

The time course of Perthes disease, the prognosis is just as unpredictable. The child’s age at diagnosis and the extent of the infestation are co-determining factors. Each Perthes runs but all of the above stages.

Treatment of Perthes’ disease

The prevention of Hüftdeformierung while maintaining the flexibility during the phase of the reduced load is also the goal of therapy, such as the restoration of the joint congruence with already occurring deformations.The three-stage treatment is dealt with monitoring and protecting the child, as well as conservative therapy Operative therapy. In general, the therapy is based on age, clinical findings (restricted movement) and changes due to the disease (stage, expansion, risk factors).Measures for relief and improved adjustment of the femoral head in the acetabulum (containment) are available as treatment instruments to choose from.

Forecast

The prognosis of Perthes’ disease depends on many factors and can not be predicted unambiguously. The prognosis depends on factors such as age of the child, degree of infestation of the femoral head and the restriction of movement. The earlier the disease occurs, the better the prognosis, however, the greater the involvement of the femoral head and the restriction of movement, the worse the prognosis.
Crucial also is a regular clinical control and a running-related therapy.

What can parents and children do it yourself?

The focus of treatment is to maintain the flexibility and protection against shock loading of the affected hip. For the period of Perthes’ disease is an exemption from school sports and other sporting activities, an independent and careful cycling or swimming is possible and even recommended. This has a counter that is also inactivity-related weight gain.