Age specific for Perthe's disease:
Ans. c (4-8 years). (Ref. Essential Orthopedics by Maheshwari, 2nd ed., 268)Perthes disease can occur between the age of 3 to 12 years, with peak incidence between 4 & 8 years.While slipped femoral epiphysis is mostly seen after 10 years of age.PERTHES' DISEASE (CALVE-LEGG-PERTHES' DISEASE)# Usually presents with a limp or pain in the groin.# Symptoms are due to avascular necrosis of the femoral capital epiphysis.# Bilateral in 5-20% of cases.# More common in boys# Usually occurs between 4 and 8 years of age.# The diagnosis is usually made on plain radiography - The earliest sign is increase in the affected hip's joint space (a nonspecific finding).- As the condition develops, subarticular lucencies become visible within the femoral capital epiphysis, which may later become flattened with loss of the perfect round appearance, sclerotic and fragmented.- The epiphysis may also be extruded laterally (an important prognostic indicator) and 25% of children will need additional treatment to contain the femoral head.- The epiphyseal changes may excite a reaction in the adjacent metaphysis with the development of cysts and coxa magna and this too indicates a poorer prognosis.- Early in the disease, subtle changes may only be visible on a frog leg lateral view, which should be performed initially and occasionally in follow up.# Ultrasound can demonstrate irregularity of the anterior and superior surfaces of the femoral capital epiphysis consistent with Perthes' disease.# MRI is sensitive as well as more specific (Investigation of choice).SLIPPED UPPER FEMORAL CAPITAL EPIPHYSIS# More common in boys, May be bilateral ; Usually presents without a history of trauma.# Classically occurs in overweight adolescents who complain of pain or limping.# Initial investigation is with plain radiography and an AP pelvis allows the hips to be compared and a check made for early contralateral abnormality.# If epiphysis has slipped, a line drawn along superior surface of femoral neck will not pass through it.# Additionally, the proximal femoral growth plate may have an indistinct appearance.# If the frontal view is normal a true lateral or frog leg view of the symptomatic hip must also be obtained as this will reveal earlier and more subtle movement of the epiphysis downwards and inwards, and allow early fixation.
Below 2 years
2-3 years
4 - 8 years
10-15 years
Pediatric Orthopedics