Management of Perthes' disease.

The main complication of Perthes' disease is femoral head deformation. Evidence from the literature highlights two important factors related to the cause and timing of this complication. (1) Extrusion of the femoral head appears to be a major factor that leads to femoral head deformation. (2) Deformation of the femoral head occurs in the latter part of the stage of fragmentation. The likelihood of preventing femoral head deformation is over 16 times higher if extrusion is reversed or prevented by the early stage of fragmentation than if done later. Several treatment options have been described in children who present later in the course of the disease but the outcomes of all these measures do not compare with those of early intervention.