Perthes disease, also called Legg-Calvé-Perthes Disease, is a medical disorder that causes poor blood circulation to the head of the femur, or thighbone, according to the Division of Pediatric Orthopaedics of Morgan Stanley Children's Hospital in New York. This deprivation, if prolonged, can lead to the fracture or collapse of bones in the hip joint, resulting in a deformity. The disease, which most commonly occurs in young boys, is sometimes treated with supportive braces.
The Scottish Rite Brace
The Scottish Rite brace is one of the most commonly used braces for treating Perthes disease, according to Morgan Stanley Children's Hospital. The Connecticut Children's Medical Center describes it as a pair of thigh cuffs separated by a telescoping spreader bar and a hinged suspension belt, and it is designed to be worn over the clothing. While it is lightweight and easily removable for rest or bathing, the Scottish Rite brace does have disadvantages, according to "Pediatric Orthopedic Deformities: Basic Science, Diagnosis and Treatment" by Frederic Shapiro. One shortcoming is that most braces of this design lack built-in hip flexion, which commonly results in patient movement that compromises the coverage of the femur anterior head. Another criticism is that this brace does not rotate the hips internally, and most patients tend to naturally rotate the hips externally when walking in the brace, further compromising femur anterior head coverage.
The Petrie Cast
Morgan Stanley Children's Hospital identifies the Petrie cast as the other most commonly used brace design for Perthes disease. According to "Pediatric Orthopedics in Practice" by Fritz Hefti et al., the Petrie cast is only used after a thorough analysis to ensure that improvement can be achieved without surgical intervention. The cast places both legs in a fixed position at maximum abduction, meaning that they are spread apart as wide as possible, and holds them at this position with a rigid separating bar. This treatment typically involves regular physical therapy under epidural anesthesia. "Staying Out of Trouble in Pediatric Orthopaedics" by David L. Skaggs and John M. Flynn warns that these casts should be padded carefully around the Achilles tendon, as pressure sores at this site are common. Mobility is necessarily limited when in a Petrie cast, and patients will require assistance with moving around, using the bathroom and getting to and from medical appointments. This type of treatment typically lasts from three to six weeks.
The Toronto Legg-Perthes Brace
The Toronto Legg-Perthes Brace, according to an article by Dr. W. P. Bobechko published in the July/August 1974 issue of Clinical Orthopaedics & Related Research, was designed to address problems encountered by users of other braces for thigh abduction. It consists of a pair of thigh cuffs separated by a rigid bar, a pair of foot supports separated by another rigid bar, and two additional support bars that extend from the thigh cuffs to the center of the foot support bar. It allows for abduction of up to 90 degrees, similarly to the Petrie cast, but provides nearly full flexion of the hips and knees, making sitting and walking possible. The brace can also be removed without difficulty for bathing and comfortable rest, but candidates for the Toronto Legg-Perthes should not walk without the brace until treatment has concluded.
References
- Division of Pediatric Orthopaedics of Morgan Stanley Children's Hospital in New York: Perthes Disease
- Connecticut Children's Medical Center: The Scottish Rite Brace
- "Pediatric Orthopedic Deformities: Basic Science, Diagnosis and Treatment"; Frederic Shapiro; 2001
- "Pediatric Orthopedics in Practice"; Fritz Hefti, Reinald Brunner, Carol C. Hasler, Gernot Jundt; 2007
- "Staying Out of Trouble in Pediatric Orthopaedics"; David L. Skaggs, John M. Flynn; 2006
