Paediatrics: Perthes Disease: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Perthes Disease🎧 A clear, high-yield breakdown of this childhood hip avascular necrosis – perfect for exam prep and real-life clinical scenarios.🧠 Key Learning Points📌 Definition• Perthes disease is a childhood hip disorder caused by temporary loss of blood supply to the femoral head, resulting in avascular necrosis and subsequent bone remodelling.📌 Causes & Risk Factors• Exact cause unknown; thought to involve vascular disruption and possible genetic predisposition• Strongest risk: Boys aged 4–10 years (peak ~6 years)• Family history• Low birth weight• Maternal smoking/exposure to secondhand smoke• More common in lower socioeconomic groupsMnemonic: “BOYS get Perthes – Boys, Ossification delay, Years 4–10, Smoking in pregnancy”📌 Pathophysiology• Interrupted blood supply to femoral head → bone cell death (avascular necrosis)• Delayed ossification and weak bone leads to collapse, flattening, and deformity• Body attempts revascularisation, but the healing process may remodel the bone abnormally📌 Symptoms• Gradual onset hip or groin pain (may radiate to knee)• Painless limp, progressing over weeks/months• Restricted hip movement (↓ abduction, ↓ internal rotation)• Sometimes thigh muscle wasting• Usually no systemic illness or feverMnemonic: “GROIN LIMP” – Gradual pain, Range of motion ↓, Onset insidious, Internal rotation limited, No fever, LIMP present📌 Differential Diagnosis• Transient synovitis (irritable hip)• Septic arthritis (must rule out urgently)• Slipped capital femoral epiphysis (older children/teens)• Sickle cell disease• Juvenile idiopathic arthritis• Trauma/fracture• Bone tumours, eosinophilic granuloma📌 Diagnosis• Plain X-rays (AP & frog-leg lateral): widened joint space, flattening or fragmentation of femoral head• MRI (gold standard if X-rays normal but suspicion high): detects early changes, extent of necrosis• Catterall/Lateral pillar classification: grades severity• Serial imaging to monitor progression• Bone scan/arthrogram if diagnosis uncertainMemory tip: “X-ray first, MRI if in doubt”📌 Management• Non-operative:Activity modification (limit high-impact), non-weight-bearing as neededPhysiotherapy to preserve range of motionNSAIDs for painSometimes abduction braces or casts (evidence mixed)• Surgical (if poor containment, older age, or severe deformity):Femoral or pelvic osteotomiesShelf procedures, arthrodiastasisSurgical containment aims to keep femoral head well-seated in acetabulum• Regular follow-up with paediatric orthopaedics📌 Complications• Femoral head deformity (coxa magna/plana/breva)• Leg length discrepancy• Early onset osteoarthritis• Persistent hip pain or stiffness• Psychological impact (due to activity restriction)📌 Prognosis• Best prognosis if diagnosed <6 years and treated early• 80%+ achieve good hip function into adulthood if well-managed• Up to 50% may develop arthritis or require hip replacement later in life if severe or untreated📎 More MSRA Resources for Perthes Disease📝 Revision Notes: https://www.passthemsra.com/topic/perthes-disease-revision-notes/🧠 Flashcards: https://www.passthemsra.com/topic/perthes-disease-flashcards/💬 Accordion Q&A Notes: https://www.passthemsra.com/topic/perthes-disease-accordion-qa-notes/🚀 Rapid Quiz: https://www.passthemsra.com/topic/perthes-disease-rapid-quiz/🎓 Full Course: https://www.passthemsra.com/courses/paediatrics-for-the-msra/#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQ&ANotes #MSRAAccordions #MultiSpecialityRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #Paediatrics #PerthesDisease