• Perthes’ disease – or rather Legg–
• 1910-the condition was described
independently by three different
• is a painful disorder of childhood
characterized by avascular
necrosis of the femoral head
• Movement restriction
– Internal Rotation
GUIDELINES TO TREATMENT
• based on an assessment of
– the stage of the disease,
– the prognostic x-ray classifications,
– the age of the patient
– The clinical features, particularly range of
abduction and extension.
Children under 6 years
• No specific form of treatment has much
influence on the outcome.
• Symptomatic treatment, including activity
modification, is appropriate.
Children aged 6–8 years
• In this group the bone age is more important
than the chronological age
Bone age at or below 6 years
• Lateral pillar group A and B (or Catterall stage I
– symptomatic treatment.
• Lateral pillar group C (or Catterall stage III and
– abduction brace.
Bone age over 6 years
• Lateral pillar group A and B (Catterall stage I
– abduction brace or osteotomy.
• Lateral pillar group C (Catterall stage III and IV)
–outcome probably unaffected by treatment,
but some would operate.
Children 9 years and older
• Except in very mild cases (which is rare), operative
containment is the treatment of choice.