Introduction:
Perthes disease in children (osteochondropathy of the hip joint) is a condition where the femoral head is damaged due to overload or other triggering factors against the background of a genetically determined defect affecting growing bones. It is one of the most common types of aseptic necrosis of the femoral head in childhood.
Causes of the Disease:
- The onset of the disease usually occurs between the ages of 2 and 12, although it can occur up to the age of 19.
- Children aged 4-8 are more commonly affected, with boys being affected 3-5 times more often than girls.
- The following factors are presumed to be triggering factors in the development of Perthes disease: minor mechanical trauma such as bruising, ligament strain, awkward movements, etc.
- Inflammation of the hip joint (transient synovitis) due to previous infections (such as tonsillitis, flu, etc.) is suspected to be one of the triggering factors.
- Metabolic disorders involving bone formation minerals such as phosphorus, calcium, and others are also implicated.
Symptoms of the Disease:
- Determining the onset time of the disease is difficult. X-rays often indicate a prolonged pathological process before its detection.
- The first clinical manifestations include the appearance of pain in the hip joint, groin, thigh, or knee joint, fatigue during physical exertion, and limping.
- Pain may occur during movement, and there may be no pain at rest.
- Examination of the child reveals limited and painful movements in the hip joint, especially during abduction and rotational movements. Atrophy of the gluteal and thigh muscles is often noticeable. There may be a difference in leg length.
Diagnosis:
- X-ray examination is carried out to diagnose the disease and determine its stage, or magnetic resonance imaging is performed for a more accurate assessment of bone and soft tissue.
Treatment of the Disease:
- Treatment of children with Perthes disease is carried out using both conservative measures and surgical methods.
- Centring of the femoral head is achieved using various orthopedic devices such as functional braces, plaster casts, and traction.
- Surgical treatment of Perthes disease aims to improve blood supply to the femur and correct biomechanical disturbances in the joint caused by deformation of the femoral head, and is indicated for stages 2-3 of the disease.
- An important factor in the treatment of the disease is therapeutic exercises, massage, and physiotherapy procedures.