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Perthes disease: prognostic factors and management
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Perthes disease was first described in a series of papers almost a century ago (1909–10). Its treatment has always been controversial and has included casts, braces, bed rest, weight bearing, non-weight bearing, physiotherapy, soft tissue release, femoral osteotomy, pelvic osteotomy and various combinations of these. Now (Ola Wiig and colleagues. The Journal of Bone and Joint Surgery. British volume 2008;90-B:1364–71) a nationwide study in Norway has assessed prognostic factors and three treatments: physiotherapy, the Scottish Rite abduction orthosis and femoral varus osteotomy.
Over a period of 5 years (1996–2000) 28 hospitals reported 425 new cases of Perthes disease. This study included 368 cases of unilateral disease followed for 5 years. Children with <50% femoral head necrosis were treated with physiotherapy. Children under the age of 6 years received physiotherapy alone if they had >80% femoral head cover. With lesser femoral head cover they were treated, according to the
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