Metaphysis in Perthes disease: a method of assessment and selection for treatment

Following the study of metaphyseal changes of Perthes disease in 100 children (126 hips), a method of selection for containment or weight-bearing was evolved by measuring, on standard anteroposterior radiographs, metaphyseal expansion and correlating this with metaphyseal decalcification. Lateral cortical decalcification of the metaphysis indicates a vulnerable hip, which must be contained until the lesion has recalcified; otherwise, weight-bearing will not affect the result. Seventy hips have been managed by this method. Sixteen were treated by containment for greater than or equal to 20 weeks. Ten were untreated. The four poor results were associated with weight-bearing when the hip was vulnerable.