Children with acute Perthes' disease have asymmetrical lower leg growth and abnormal collagen turnover

Figures & data

Table 1.  Clinical characteristics of patients with Perthes' disease studied longitudinally

Case No.	Age (years)	Sex	Weeks of symptoms	Side	Classification		Arthrographic shape
					C^a	H^b
1	5.6	F	12	L	3	B	mild flattening
2	8.5	F	6	R	3	B	mild flattening
3	4.3	M	8	L	3	A	mild flattening
4	5.3	M	8	R c	4	C	moderate flattening
5	6.7	M	3	L	3	B	moderate flattening
6	7.2	M	6	L	3	B	moderate flattening
7	9.7	M	8	R	4	B	moderate flattening
8	9.8	M	2	L	2	A	spherical
9	11.3	M	6	R	3	B	spherical

^a C: Catterall group (1–4) (Catterall 1971)

^b H: Herring classification (A–C) (Herring et al. 1992)

^c Patient had had Perthes' disease of the left hip 2 years previously.

Table 2.  Biochemical markers in 15 children studied cross−sectionally at acute presentation with Perthes' disease, and in 9 of these children studied longitudinally for up to 2 years

Marker	Cross−sectional group (n = 15)	Longitudinal group (n = 9)	Longitudinal changes^a
	Week 1	Week 1	Week 12	Year 2
IGF-I	−0.64 (−1.03 to −0.26)^b	−0.69 (−1.20 to −0.18)^b	−0.01 (−0.47 to +0.46)	−0.09 (−0.82 to +0.65)
IGFBP–3	+0.34 (−0.15 to +0.84)	+0.11 (−0.59 to +0.81)	+0.57 (+0.30 to +0.85)	+0.58 (0.00 to +1.15)
P3NP	−1.69 (−2.28 to −1.09)^c	−1.64 (−2.49 to −0.80)^c	+0.69 (−0.41 to +1.80)	+0.16 (−2.07 to +2.40)
PICP	−1.02 (−1.44 to −0.60)^c	−1.19 (−1.84 to −0.53)^c	+0.86 (+0.18 to +1.54)	+0.70 (−0.21 to +1.60)
ICTP	+0.84 (+0.48 to +1.20)^c	+0.76 (+0.22 to +1.30)^b	−0.11 (−0.66 to +0.45)	−0.01 (−0.89 to +0.87)
Bone ALP	−0.13 (−0.40 to +0.15)	−0.15 (−0.57 to +0.28)	+0.53 (−0.10 to +1.16)	+1.15 (+0.06 to +2.24)

Data are expressed in mean (95% confidence intervals) SD scores for age and sex.

^a Longitudinal changes are calculated as SD score at time specified minus the SD score in week 1.

^b P <0.05,^cp <0.001 compared with reference population.

Figure 1. LLLV during the first week following presentation in the unaffected leg compared with the affected leg. Only the 6 patients in whom lower leg measurements were available for both weeks 1 and 2 are shown. Circles (unbroken lines): patients with unilateral Perthes' disease. Squares (dashed line): boy with bilateral Perthes' disease (see text).

Figure 2. Changes in LLLV during the first 12 weeks following acute onset of Perthes' disease. Week 2 (n = 6), week 6 (n = 7), week 12 (n = 7). Data are plotted as mean and 95% confidence intervals of the mean. Squares (unbroken, thick line): affected leg. Circles (dotted line): unaffected leg.

Catterall A. The natural history of Perthes' disease. J Bone Joint Surg (Br) 1971; 53: 37–52

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Herring J A, Neustadt J B, Williams J J, Early J S, Brown R H. The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop 1992; 12: 143–50

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