In Perthes disease, a 9-year-old boy has Herring lateral pillar Grade C involvement. According to the current evidence, which treatment is associated with better radiographic outcomes at skeletal maturity?

• A Conservative management with crutches and physiotherapy alone
• B Bracing in abduction (Petrie casts or Scottish Rite orthosis)
• C Surgical containment by femoral varus derotation osteotomy (VDRO) or Salter innominate osteotomy ✓
• D Core decompression to reduce intra-osseous pressure

Explanation

The multi-centre international Perthes Study Group trial demonstrated that for children ≥ 8 years of age with lateral pillar Grade B/C or Grade C disease (worst prognosis), surgical containment — femoral varus derotation osteotomy or Salter innominate osteotomy — produces significantly better Stulberg radiographic outcomes at skeletal maturity compared to non-operative treatment. Bracing showed no benefit over observation in this trial. Core decompression is used for avascular necrosis in adults, not Perthes disease in children.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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