An 8-year-old boy with Perthes disease has Herring lateral pillar Group B involvement with subluxation of the femoral head and loss of containment on abduction radiographs. Which operative option directly addresses the loss of containment?

• A Core decompression of the femoral neck
• B Valgus extension osteotomy of the proximal femur
• C Arthrodiastasis with external fixator as the only described containment method
• D Femoral varus derotation osteotomy or Salter innominate osteotomy ✓

Explanation

Containment surgery aims to keep the vulnerable, plastic femoral head inside the acetabulum during reossification. In children over about 6 to 8 years with Group D or D/C disease and loss of containment, a femoral varus derotation osteotomy or a Salter innominate osteotomy achieves this. Core decompression addresses vascularity, not containment, and valgus osteotomy is a salvage procedure for hinge abduction, the opposite geometry.

Reference: Lovell and Winter's Pediatric Orthopaedics, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.