Perthes' disease in children: what it is and how to treat it

Perthes disease refers to aseptic necrosis, affecting the hip joint, in which necrosis of the femoral head tissue occurs. In case of aseptic damage, the disease is not caused by infections.

Most often Perthes' disease is fixed in a child aged 3 to 14 years, mainly in boys. Usually necrosis of a spongy substance begins in the right hip joint.

Causes of the disease

At the present stage of the study of the disease, its etiology (origin) and pathogenesis (the causes of development) are still not precisely established, and the views of scientists on these questions diverge.

With Perthes' disease in childrenthe main cause of its occurrence is usually myelodysplasia. With this disease, congenital anomalies in the development of the spinal cord are noted, the innervation (nerve tissue maintenance for their interaction with the central nervous system) hip joints.

In this case, instead of a dozen large arteries, vessels and nerves that provide blood flow and innervation of this zone in the head of the thigh, the child from birth there are only a few underdeveloped arteries, unable to fully provide the function of blood flow, sufficient oxygen supply and useful substances.

However, the disease begins only when the blood supply of the joint completely stops due to its inflammation or even a slight injury that compresses the vessels. Inflammation can be caused by infectious diseases, for example, a common cold, and trauma occurs unnoticed neither for parents, nor for the child himself, as a result of very simple actions - jumping or running. Delivery of blood to the head of the thigh is completely blocked, and the formation of necrotic foci begins.

Causes of the disease can also be:

1. Complications after the transferred diseases, for example, a rickets or a hypotrophy.
2. Constant physical stress on the hip joints in children experiencing growth and weight deficit.
3. Congenital malformations of joint development.
4. Insufficient weight in the child at birth.
5. Metabolic disorders.
6. Injuries of various origins.
7. Smoking in the presence of a child.

Symptoms of the disease

When the disease symptoms gradually increase.

The development of the disease goes through 5 stages:

1. There is a slight lameness and minor pain in the knee or thigh. This is usually not paid attention. This is very carefree, because at this stage the first foci of necrosis in the head of the femur already appear.
2. The child can begin to drag a foot, he has sharp temperature jumps. When analyzing the blood it becomes clear that the body is inflamed. Often at this stage, the head of the joint, its fractures, is destroyed.
3. Painful sensations are growing. The neck of the hip is shortened due to the cessation of the growth of the baby's bone. Lameness is very noticeable, the buttock and the muscles of the affected area begin to undergo hypotrophy. The child has a disorder of the vegetative-vascular system - excessive sweating, the diseased leg has pale cold covers, the skin on the foot is wrinkled.
4. Bony-cartilaginous tissues degenerate into connective tissues.
5. In the newly formed connective tissues begins the deposition of calcium, they become ossified, and the joint ceases to function.

Parents need to be attentive even to minor injuries and pathologies of their child's development, especially if he was born prematurely, weighing less than 2 kg. With Perthes' disease, the symptoms quickly increase, and the treatment of the advanced stage may require a lot of effort.

Methods of treatment

Early diagnosis helps to avoid unnecessary problems. Refer to an orthopedist immediately when the child begins to limp and complain of pain in the knee or groin.

The pathological process develops throughout the long months, and only very inattentive parents can overlook it. And the doctor, in addition to a visual examination, will prescribe the radiography of aching joints, ultrasound and radiation examination.

With Perthes' disease in children, treatment includes the following conservative complex methods:

1. Measures are being taken to improve blood circulation in the affected area.
2. The load of the diseased limb is excluded - with the help of a langet, a plaster bandage, the diseased limb is fixed and stretched. Also functional buses of Vilensky, Mirzoyeva, plaster bandages-Lange's langs, which reduce the pressure on the joint, are used.
3. There is a stimulation for resorption of foci of necrosis and the formation of new bone tissue.
4. Measures are being taken to eliminate the muscle atrophy that has arisen.
5. The child is engaged in strengthening gymnastics, the exercises of which are prescribed by the doctor, so as not to damage the newly formed bone tissue.
6. Massages are conducted.
7. There are courses of physiotherapy - ultrasound, UHF, electrophoresis with calcium iodide and chloride.
8. That there was no stagnation (stasis) of blood in the arteries, thermal procedures are carried out only at the third stage of the disease. Recommended warm baths, wrapping mud, paraffin.
9. All procedures can be completed with aerotherapy (air-hardening) and heliotherapy (exposure to sunlight).
10. Food is prescribed enhanced, with increased content of minerals, proteins and vitamins. It is especially important to replenish the reserves of calcium, which will go to build a new bone. Also from trace elements give phosphorus and sulfur in combination with ascorbic acid.
11. Chondroprotectors, which tighten the cartilaginous tissues, and antioxidants that prevent cartilage destruction are prescribed.

Surgical methods of treatment are not used often, only in those cases when the joint is completely destroyed. If, with a strong muscle atrophy, they are shortened, a surgical operation is prescribed to prolong them. If the location of the joint head is disturbed, an operation is sometimes performed to direct it into the acetabulum.

Complications of Perthes disease

If the diagnosis is not timely, the treatment is delayed. In the case of severe lesions, a complete atrophy of the muscles of the diseased limb occurs, in which they have insufficient mass. Buttock and muscles dry up, it becomes also a cosmetic defect, besides the factor threatening health.

Perthes' disease in children can create problems with walking- there is lameness, a feeling of stiffness in the joint. The necrosis of a part of the bones, the formation of foci of necrosis pose a serious threat to the entire body, as further intoxication occurs. At the site of the damaged area, a new one is easily formed in children, but it can be deformed, which will affect the performance of the entire limb.

Preventive measures

At birth of a premature baby with a body weight of less than 2 kg, parents should always be vigilant with injuries of the lower extremities. The child must constantlyreceive adequate nutrition, excluding fast food, food should be rich in calcium.

Perthes' disease involves long-term treatment, so it is always better to be safe and call the specialist on time.