Article information
Abstract
Perthes’ disease is an idiopathic avascular necrosis of the proximal femoral epiphysis in children. Plain radiograph is the main diagnosis tool and is also used to classify the phase and the extent of the disease. Although it is a self-limited condition and its natural history is often benign, there are several factors that can worsen prognosis. Those factors are age, extent of the disease and some radiological signs and are useful to identify patients who will benefit the most from treatment. Adequate containment of the femoral head within the acetabulum resulting in a more spherical and congruous joint is the main goal of treatment, which is based mainly on surgical techniques, such as femoral or acetabular osteotomies. It has been shown that orthopaedic containment methods, like abduction orthosis, have not achieved better results.
Keywords:
Legg-Calvé-Perthes disease
Avascular necrosis
Proximal femoral epiphysis
Resumen
La enfermedad de Perthes es una necrosis isquémica idiopática de la epífisis femoral proximal en niños. La prueba diagnóstica más utilizada es la radiografía simple, que además permite clasificar la enfermedad en función de su evolución y de su extensión. Aunque su historia natural, autolimitada en el tiempo, es generalmente benigna, existen una serie de factores asociados a un pronóstico menos favorable. Estos factores son la edad, la extensión de la enfermedad y determinados signos radiológicos, y definen a aquellos pacientes que más se van a beneficiar del tratamiento. La contención de la cabeza femoral en el acetábulo para permitir un óptimo remodelado de la misma es el objetivo del tratamiento que actualmente se basa en métodos quirúrgicos como las osteotomías femorales o acetabulares. Los métodos de contención ortopédicos como las ortesis de abducción no han demostrado obtener mejores resultados.
Palabras clave:
Enfermedad de Legg-Calvé-Perthes
Necrosis isquémica
Epífisis femoral proximal
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