Stage III shows progression into the lateral column of the head, and IV is whole head involvement. The Stulberg classification describes the end result after healing of Perthes, in terms of sphericity and congruity of the femoral head with the acetabulum. Causes The etiology of Perthes disease is unknown, but most current theories are based on vascular embarrassment of the femoral head. Minor trauma may have a role in initiating events in any of these theories. Overview of Care Restoration of joint motion is critical to maintaining synovial and therefore cartilage nutrition.
Containment is the principle of keeping the femoral head in the acetabulum and preventing deformity.
The osteotomy is usually fixed internally so that early motion may be started. Sometimes, both osteotomies are necessary. If the head is not containable, salvage procedures can reduce pain, equal the leg length, and improve movement. Surgery is not recommended for children under age six unless significant subluxation is shown to occur. In almost all cases, symptoms resolve after the healing phase and the patients have freedom from pain during the teenage years.