Perthes Disease, A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

By Kenneth Kee

This book describes Perthes Disease, Diagnosis and Treatment and Related Diseases
Perthes disease (also termed Legg-Calve-Perthes) is a rare childhood disorder that involves the proximal femoral epiphysis of the hip.
It normally happens in children who are between 4 and 10 years old.
It happens when the blood supply to the rounded head of the femur (thighbone) is temporarily interrupted.
Without a sufficient blood supply, the bone cells die, a process termed avascular necrosis.
Cause
The cause of Perthes disease is not identified.
Some recent studies indicate that there may be a genetic linkage to the formation of Perthes, but more research needs to be done.
Risk factors
1. Positive family history 10%
2. Low birth weight (less than 2.5 kg in boys)
3. Abnormal birth presentation
4. Second hand smoke exposure
5. Asian, Inuit, and Central European descent
6. Low socioeconomic status
Osteonecrosis happens secondary to interruption of blood supply to femoral head
This is accompanied by revascularization with subsequent re-sorption and later collapse
Creeping substitution supplies pathway for remodeling or healing after collapse
Maternal/passive smoking exacerbates the development of the disorder.
This disorder is a self-limiting process.
There is a inconsistent course to final healing from the first ischemic incident.
This can take 2-5 years to recover.
The disorder is distinguished from adult osteonecrosis by its capability to heal and remodel
While the term "disease" is still utilized, Perthes is really a complex process of different stages that can persist several years.
Stages
1. Initial/necrosis
In this stage of the disease, the blood supply to the femoral head is interrupted and bone cells die.
The region is intensely inflamed and irritated and the child may start to show signs of the disease, such as a limp or different way of walking.
Infarction causes a smaller, sclerotic epiphysis with medial joint space widening.
Radiographs may remain normal for 3 to 6 months.
This first stage may persist for several months.
Fragmentation
Fragmentation starts with evidence of sub-chondral lucent line (crescent sign)
Femoral head seems to fragment or dissolve.
Over a period of 1 to 2 years, the body takes away the dead bone and quickly replaces it with an early, softer bone ("woven bone").
It is during this stage that the bone is in a weaker state and the head of the femur tends more likely to break apart and collapse.
This is the effect of revascularization process with bone re-sorption causing collapse with subsequent patchy density and bone lucencies.
This stage can persist from 6months to 2years.
Re-ossification
New, stronger bone forms and starts to take shape in the head of the femur.
Ossific nucleus goes through re-ossification with new bone showing as necrotic bone is re-sorbed
The re-ossification stage is often the longest duration of the disease and can persist a few years.
Healed
Femoral head heals and remodels until skeletal maturity.
Healing starts once ossific nucleus is fully re-ossified; trabecular patterns re-appear.
In this stage, the bone re-growth is total and the femoral head has achieved its final shape.
One of the earliest signs of Perthes is an alteration in the way the child walks and runs.
The child may limp, have restricted motion, or develop a peculiar running style.
Perthes disease normally restricts the abduction and internal rotation of the hip
Imaging studies are critical in diagnosis and prognosis
The purpose of treatment is to alleviate painful symptoms, defend the shape of the femoral head, and recover normal hip movement.
The easiest treatment is observation alone, activity restriction and physical therapy
TABLE OF CONTENT
Introduction
Chapter 1 Perthes Disease
Chapter 2 Causes
C

• Language: English
• Publisher: Kenneth Kee
• Release date: Sep 14, 2019
• ISBN: 9780463774953

Kenneth Kee

Medical doctor since 1972.Started Kee Clinic in 1974 at 15 Holland Dr #03-102, relocated to 36 Holland Dr #01-10 in 2009.Did my M.Sc (Health Management ) in 1991 and Ph.D (Healthcare Administration) in 1993.Dr Kenneth Kee is still working as a family doctor at the age of 74However he has reduced his consultation hours to 3 hours in the morning and 2 hours inthe afternoon.He first started writing free blogs on medical disorders seen in the clinic in 2007 on http://kennethkee.blogspot.com.His purpose in writing these simple guides was for the health education of his patients which is also his dissertation for his Ph.D (Healthcare Administration). He then wrote an autobiography account of his journey as a medical student to family doctor on his other blog http://afamilydoctorstale.blogspot.comThis autobiography account “A Family Doctor’s Tale” was combined with his early “A Simple Guide to Medical Disorders” into a new Wordpress Blog “A Family Doctor’s Tale” on http://ken-med.com.From which many free articles from the blog was taken and put together into 1000 eBooks.He apologized for typos and spelling mistakes in his earlier books.He will endeavor to improve the writing in futures.Some people have complained that the simple guides are too simple.For their information they are made simple in order to educate the patients.The later books go into more details of medical disorders.He has published 1000 eBooks on various subjects on health, 1 autobiography of his medical journey, another on the autobiography of a Cancer survivor, 2 children stories and one how to study for his nephew and grand-daughter.The purpose of these simple guides is to educate patient on health disorders and not meant as textbooks.He does not do any night duty since 2000 ever since Dr Tan had his second stroke.His clinic is now relocated to the Buona Vista Community Centre.The 2 units of his original clinic are being demolished to make way for a new Shopping Mall.He is now doing some blogging and internet surfing (bulletin boards since the 1980's) startingwith the Apple computer and going to PC.The entire PC is upgraded by himself from XT to the present Pentium duo core.The present Intel i7 CPU is out of reach at the moment because the CPU is still expensive.He is also into DIY changing his own toilet cistern and other electric appliance.His hunger for knowledge has not abated and he is a lifelong learner.The children have all grown up and there are 2 grandchildren who are even more technically advanced than the grandfather where mobile phones are concerned.This book is taken from some of the many articles in his blog (now with 740 posts) A Family Doctor’s Tale.Dr Kee is the author of:"A Family Doctor's Tale""Life Lessons Learned From The Study And Practice Of Medicine""Case Notes From A Family Doctor"

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