Perthe’s disease

Case discussion

case

• Sandhya Gaire• 6 yr 7 mths old girl• Grade I student• Informant uncle• c/o- pain rt groin X 6-7 mths• occasional limp

• Pain dull aching in nature• Aggravated by exertion and sitting down in

squatting position• No radiation• NO h/o trauma, fever, rashes

Examination

• Gait- antalgic on exertion• Cannot sit cross legged• Can squat• Trendelenberg test negative• Tenderness +ve on anterior hip jt line

Range of motion

• Flexion 140-140• Extension 10-15• Adduction 40-40• Abduction 30-60• Ext rot in ext – 30-30• Ext rot in flex – 50-50• Int rot in ext – 10-20• Int rot in flex – 0-20

• Wasting of thigh 2cm• Wasting of calf 0.5 cm• No LLD• Telescoping test –ve• Sectoral sign +ve

3 months follow up

• Intensity of pain increased• Limp increased• Parents are worried

Changes in findings

• Int rot in ext – 20-20• Int rot in flex -10-20• Abduction – 45-60

To the floor

What next?