PERTHIS DISEASE
it is osteochondritis affecting the capital epiphysis of upper
end of femur
it occurs in children between 5to10years and more in boys
it is usually unilateral but sometimes bilateral
Eitology- mild trauma, metabolic disturbance infiammation
perthis disease
• pathology- AVN,of HOF interfears with
blood supply ,followed by healing process
of revascularisation
• stages -- stage1 -- ischemia and bone
death femoral head is partially or
completely dead
• cartilaginious part of femoral head being
nourished by synovial fluid remains visible
and become thicker than normal
perthis disease
• thickning and oedma of synovium and
capsule
• stage 2 revascularisation and rapair
• dead marrow is replaced by granulation
tissue with in weeks of infarction
• bone is revascularised and new bone is
laid down
• stage 3 -- distortion and remodeling
• if repair is rapid and complete architecture
may be restored before femoral head
looses its shape
• if repair is slow , collapse of bony
epiphysis , distortion of femoal head and
neck
• C/F -- pain - C/O pain in groin and thigh
refered to the knee
• hip musculature -- wasting is noted
• LLD - affected limb appares shorter than
normal
• limp -- child walk with limp
• pt has diffculty in swing through & limp is
accompained by exaggerated trunk and
pelvic movement
perthis disease
• invg -- radiograph
• asymmetry of ossific centers
• collapse and sclerosis of epiphysis of
femoral head
• increased jt space
• flattening and lat displacement of
epiphysis
• rarefaction and widening of metaphysis
once
• Rx - acute stage child must be
immoblised so as to avoid wt on affected
hip
• immoblisation is done by skin traction
• hip is maintained in postion of flexion , ER
• sub acute stage -- once irritablity has
subsided ,usually take around 3 weeks
symptomatic Rx is encouraged
• pain is controlled by traction
• gentle ex are started to maintain
movement
• ambulation is allowed
• child is not supposed to play sports or
strenous activity
• chr stage -- it is group 3 and 4 pt in which
head is not deformed but utmost care is
required
• containment of femoral head into actabular
cavity is the main aim of Rx
• conservative Rx -- hips are held in a
position of abd so that femoral head is
totally covered by actablum this is attained
by pop cast , brace , splint
• suragical Rx -- varus ostotomy of proximal
femur
• innominate osteotomy of pelvis
• slater osteotomy
• valgus femoral osteotomy
• pt managment -- aims of Rx
• maximizing ROM
• improve muscle strength
• ambulation of pt
• pt during application of skin traction --
• application of cryotherapy , moist heat to
reduce MS as it leads to pain and
deformity
• isometrics to glutie , hip abd , Qceps
• if skin traction is intermittent small range
passive movements can be started
• PT following skin traction --
• postural correction of limb -- proper
posture of affected limb is to be
maintained so that the limb does not rest
in unwanted postion for long time causing
stretch and stress on muscles & joints
• ROM ex -- affected hip is moved through
full range of movement so as to maintain
muscle flexiblity and physiological
properties
• spl attention to Abd & IR should be given
• prevention of contractures -- cont
streatching of hip flexors
• sessions of prone lying
• increase muscle strength - active assisted
ex , active ex , resisted ex to hip jt
• eccenteric ex
• isometrics at termina range of movement
• ambulation & gait training -- initally NWB
standing and walking is taught in parallel
bars , then progressed to waker and then
to axillary crutches
• transfer activities should be taught
