A 5-year-old boy is diagnosed with Perthes disease affecting 60% of the femoral head (Herring lateral pillar Grade C). According to current evidence-based treatment guidelines, what is the appropriate management?
- A Observation only with bed rest and traction
- B Bracing with Toronto brace for 2 years
- C Containment treatment — surgical varus osteotomy or Salter innominate osteotomy ✓
- D Hip replacement at diagnosis
Explanation
The Herring lateral pillar classification is the most prognostically useful: Grade A (intact lateral pillar) — good outcome without treatment; Grade B (>50% lateral pillar height maintained) — intermediate, age-dependent; Grade C (<50% lateral pillar height) — worst prognosis, benefits from containment. Children >8 years old with lateral pillar Grade B/C benefit from surgical containment (varus proximal femoral osteotomy or Salter pelvic osteotomy) to maintain the femoral head within the acetabulum during revascularization. Bracing (Petrie cast/A-frame) was previously used but has largely been replaced by surgical containment for severe cases. Hip replacement is for end-stage disease in adults.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.