[Premature femoral head growth plate closure in Perthes' disease]

The study population consisted of 311 patients (50 female and 261 male) who had reached skeletal maturity at last follow up (361 hips). The mean age at the onset of symptoms was 6 years and 10 months (range: 2.5-13 years). All patients were treated by containment methods (bed rest and traction in abduction, brace, Petri cast, varus osteotomy, Salter osteotomy and shelf operation). Premature growth plate closure was estimated according to Bowen (central and lateral). Necrosis of the femoral head was classified according to Herring and Catterall, late results according to Stulberg and Mose and leg length discrepancy on scanograms. Article-trochanter distance (ATD) was estimated according to the Edgren methods. Premature femoral head growth plate closure was found in 61 hips (central--41 and lateral--20). Statistical analysis did not reveal any correlation between the gender and type of treatment and premature growth plate closure. The central pattern of growth plate closure was more often seen to 6 years of age at the onset and the lateral over 9 years of age at the onset (p = 0.0176). Premature growth plate closure was observed more often in Herring group C and Catterall group 4 (p = 0.0001). Disturbances in femoral head sphericity according to Mose increased (except with bilateral Perthes' disease) and ATD decreased in patients with premature growth plate closure. Also premature growth plate closure increased the leg length discrepancy in Perthes' disease. Thirty two (52.5%) hips with abnormal physeal growth were classified into type I or II according to Stulberg classification, 16 (26.2%) into type III and 13 (21.3%) into type IV or V. Premature growth plate closure in Perthes' disease is more common in huge necrosis of the femoral head. The central pattern of growth plate closure is more often in younger children (to 6 years of age) and the lateral in older (over 9 years of age). With abnormal physeal growth the greater trochanter overgrow and ATD decreased, the leg length discrepancy and disturbances in sphericity of the femoral head increased. Premature growth plate closure increased satisfactory and poor results according to Stulberg classification.