2nd-order laboratory parameters-depending on the results of the history, physical examination, and obligatory laboratory parameters-for differential diagnostic clarification. Small blood count Differential blood count Inflammatory parameter – CRP (C-reactive protein)
Therapeutic target Pain relief Therapy recommendations Analgesia (pain relief) according to WHO staging scheme: Non-opioid analgesic (paracetamol, first-line agent). Low-potency opioid analgesic (e.g., tramadol) + non-opioid analgesic. High-potency opioid analgesic (eg, morphine) + non-opioid analgesic. If necessary, anti-inflammatory drugs / drugs that inhibit inflammatory processes (non-steroidal anti-inflammatory drugs, NSAIDs), eg acetylsalicylic acid (ASS), ibuprofen. See … Perthes Disease: Drug Therapy
Obligatory medical device diagnostics. Radiographic examination of the pelvis (a. p., Lauenstein). Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification. Sonography (ultrasound examination) of the hip. Magnetic resonance imaging(MRI; computer-assisted cross-sectional imaging method (using magnetic fields, that … Perthes Disease: Diagnostic Tests
Note Therapy for Perthes disease should usually be conservative (e.g., physiotherapy and self-exercise; positioning elements for sleep). The younger the patient and the lower the Catterall group (see classification below), the more cautious one should be with the indication for surgery. In Perthes disease, the following surgical therapies are used: Femoral-side procedures such as intertrochanteric … Perthes Disease: Surgical Therapy
Medical history (history of illness) represents an important component in the diagnosis of Perthes disease. Family history Does your family have a history of frequent skeletal system disorders? Social history Current medical history/systemic history (somatic and psychological complaints). What changes have you noticed in your child? How long have these changes existed? Does the child … Perthes Disease: Medical History
Endocrine, nutritional, and metabolic diseases (E00-E90). Gaucher disease – genetic disorder with autosomal recessive inheritance; lipid storage disease due to defect in the enzyme beta-glucocerebrosidase, resulting in storage of cerebrosides primarily in the spleen and marrow-containing bones. Ossification disorders (bone formation disorders) in hormonal disorders, unspecified. Musculoskeletal system and connective tissue (M00-M99). Bacterial coxitis (inflammation … Perthes Disease: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by Perthes disease: Musculoskeletal system and connective tissue (M00-M99). Secondary coxarthrosis (hip joint arthrosis).
Catterall groups The severity and spread of Perthes disease are classified as follows: Stage Description I Anterolateral (“front and side”) involvement without sequestrum (dead piece of bone), metaphyseal involvement (metaphysis: section of long bones that lies between the bone shaft (diaphysis) and the epiphysis), and subchondral (articular bone on which cartilage rests) fracture (broken bone) … Perthes Disease: Classification
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; furthermore: Inspection (viewing). Skin (normal: intact; abrasions/wounds, redness, hematomas (bruises), scars) and mucous membranes. Gait (fluid, limping) [painful restriction of movement in hip joint → laziness in walking, rapid fatigue; limping]. Body … Perthes Disease: Examination
The following symptoms and complaints may indicate Perthes disease: Leading symptoms Painful restriction of movement in the hip joint → laziness to walk, rapid fatigue. Limping Muscular atrophy Abduction contracture (musculoskeletal disorder; prolonged immobilization results in permanent stiffening of the joint, spreading the affected limb away from the body). Joint effusion (Hydrops articularis)
Pathogenesis (development of disease) The exact pathogenesis of Perthes disease is not yet clear. Several pathogenetic factors are discussed that may play a role: Subcritical vascular supply Constitution/skeletal retardation Multiple bone infarcts There is then a local tissue destruction (necrosis) in the area of the epiphysis (joint end with bone core). The consequence is a … Perthes Disease: Causes
General measures Bed rest in the acute stage (with extension/stretching if necessary). Gait training – aims to maintain hip mobilityNote: Mostly young children may continue to jump around, swim or ride bicycles. Positioning elements for sleeping Conventional non-surgical therapy methods Analgesics (painkillers) Medical aids Orthotic fitting, if applicable (orthosis: medical device used to stabilize, relieve, … Perthes Disease: Therapy
