How is Perthes's disease manifested and treated in the child?
Perthes disease refers to the pathologies of bones andjoints and is characterized by the destruction of the femur, and potentially the entire hip joint. The disease occurs in childhood, and it happens in children is not so rare, but parents, unfortunately, in most cases do not even suspect about this disease. Perthes' disease in children, whose symptoms are not detected in the first stages of the course, is already diagnosed when changes have occurred in the hip joint. Children under the age of five rarely suffer from this disease, it is more typical for children aged six to ten years, more often boys.
Until now, it has not been possible to fully establishcauses of the disease. It is believed that the bone is destroyed as a result of worsening of the circulation in the joint, which is due to injuries, metabolic disorders, transferred infections, vascular anomalies, and for other reasons.
As already mentioned, in the initial stages of the signspathologies are almost not expressed. Over time, there is minor lameness, it can disappear after rest, and then again appear. Often children complain of pain not in the hip, but in the knee joint, as the pain radiates to the knee. Such pain can appear during the day when walking. As Perthes' disease progresses in the child, one can notice a slight decrease in the soft tissues of the lower leg and thigh in the volume, the restriction of extension and rotation of the hip joint. Usually such signs are not given due attention, or they do not go unnoticed, because the general condition does not change.
Stages of the disease
The child's Perthes disease develops slowly. At the first stage - the stage of subchondral necrosis - the head of the femur begins to flatten. The second stage - the stage of the impression fracture - is manifested by the compaction with an even greater flattening of the femur. At the third stage - the stage of bone fragments formation - the bone can stop growing, it is possible the development of subluxation (the exit of bone from the hollow of the joint). The fourth stage is the stage of restoring the structure, and the fifth is the stage of the consequences. Despite the fact that the structure of the femur is completely restored, the shape of its head remains deformed more often, which leads to a permanent irreversible disruption of the functioning of the joint. On X-ray images, you can clearly see Perthes's disease at any stage, but because the characteristic symptoms of the disease are absent, radiography is in most cases carried out with great delay.
Can be applied conservatively orsurgical treatment. In the first case, the unloaded limb is unloaded by assigning the child to a bed rest and then walking on crutches. Along with this, general restorative therapy is carried out, consisting of taking vitamins, performing physiotherapy procedures, massage, and therapeutic gymnastics. Only when the structure of the head of the femur is fully restored, you can begin to walk with full load on the leg. Operative treatment is aimed at stimulating the restoration of the circulatory system in the joint.
