Perthes Disease: Causes, Symptoms, Risk Factors, Diagnosis, Treatment and Complications

Perthes disease in children is caused by a temporary disruption in blood flow to the femoral head, or ball, of the hip joint. This disruption results in the bone deteriorating.

This decaying bone may eventually shatter and no longer be spherical. As soon as the body receives fresh blood, the ball will finally mend. Following recovery, discomfort and stiffness may occur if the ball loses its spherical form. Bone regeneration, fracture, and mortality may occur in stages that take years to complete.

Several procedures are used by doctors to hold the ball firmly in the socket, maintaining the joint's circular shape. With the socket acting as a mold, the fractured femoral head heals.

Causes  Of Perthes Disease

Perthes disease arises from inadequate blood supply to the femoral head, or ball, component of the hip joint. Inadequate blood flow causes this bone to weaken and fracture easily. The cause of the transient drop in blood flow to the femoral head is yet unknown.

Symptoms Of Perthes Disease

Indicators and indications of Perthes disease include:

• Limping
• Pain or stiffness in the knee, groin, thigh, or hip
• Limited range of motion in the hip joint
• Pain that worsens with movement and gets better with relaxation
• Perthes often affect a single hip. Hip pain occurs in both hips for some children, often at different times.

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Risk Factors of Perthes Disease

Risk factors for Perthes disease include:

• Age: Perthes disease can strike children at any age, but it often shows symptoms between the ages of 4 and 10.
• Sex: Perthes are nearly four times more common in boys than in girls.
• Race: White children are more likely to get the illness than Black youngsters are.
• Genetic code alterations: The onset of Perthes disease is associated with gene alterations in a small subset of cases, although further research is needed to confirm this.

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Diagnosis  Of Perthes Disease

During the physical examination, your doctor may move your child's legs into various positions to evaluate the range of motion and find out whether any of the postures hurt.

Imaging tests

Vital in determining the presence of Perthes disease, these tests may include:

• Radiography: Initial X-rays may appear normal because Perthes disease abnormalities take one to two months to manifest on X-rays after symptoms begin. Your doctor will likely recommend multiple X-rays over time to track the disease's progression.
• MRI: This technique uses a strong magnetic field and radio waves to produce extremely detailed images of the bones and soft tissues of the human body. MRIs can often reveal bone degradation caused by Perthes disease more clearly than X-rays, while they are not always necessary.

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Treatment  Of Perthes Disease

Perthes disease may require several years to complete the entire process of bone death, fracture, and rejuvenation. The recommended treatment plan will be decided by the:

• Age when the symptoms initially manifested.
• Hip injury severity and disease stage.

As Perthes disease progresses, the femoral head, the ball component of the joint weakens and fractures. The part of the joint that makes up the socket can serve as a mold to maintain the spherical shape of the fractured femur head as it heals.

For this molding to work, the femoral head must slide into the socket securely. An occasional leg cast that spreads the legs widely apart for four to six weeks may assist in this.

For some children, surgery is required to keep the joint ball firmly in its socket. This procedure may involve making wedge-shaped incisions in the thigh or pelvic bone to realign the joint.

Generally, surgery is not necessary for children under six. In this age group, the hip socket is more naturally moldable, therefore the ball and socket typically continue to fit well without surgery.

Alternative medical interventions

• Some children particularly the very young may only need to be observed or receive conservative therapy. Conservative medical procedures could include:
• Restrictions on activities: No vigorous activities that could exacerbate hip degeneration, such as jumping or sprinting.
• Crutches: There may be times when your child needs to avoid bearing any weight on the damaged hip. Crutches are useful for protecting joints.
• Medical physicals: A tight hip can cause the surrounding muscles and ligaments to shorten. The hip's flexibility can be preserved with exercises that stretch it.
• Medications that reduce inflammation: Your pediatrician might recommend ibuprofen or naproxen sodium to help ease your child's pain.

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Complications  Of Perthes Disease

Perthes disease is more common in adults with hip arthritis, particularly if the hip joint heals oddly. If, following healing, the hip bones do not fit together correctly, the joint may wear out before its time.

After the age of six, hip problems are typically more prevalent in children with Perthes. As the kid becomes older after diagnosis, the chance that the hip joint will heal in a normal, spherical shape improves.

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