Posted by Sheila on December 21, 2003 at 08:44:21:
In Reply to: old fashioned treatments posted by Keith on December 21, 2003 at 08:06:06:
Hi Keith,
Actually here in the UK there is a lot of children who are still treated with the watch and wait (conservative way) approach.
Each consultant has their own preferred way of managing the condition. There is no cure as you know it has to run its course.
For some children surgery is needed for very valid reasons.
No two perthes children present identically and all lead different lives and sometimes we find children who live in hilly areas are given crutches and equipment more than those living in flat areas or cities.
I also think the doctors are now looking at the whole of the perthes child and not just the clinical aspect as restricting a child aged 5-10yrs old in a cast has a social as well as emotional impact on their development.
with the brace method view it is often viewed as 'external surgery' ! and will depend on how well the child tolerates it as much as how well the parents cope with it...
I feel surgery does not cure perthes but makes the condition more manageable for a hopefully better long term prognosis. After all they are going to be longer an adult than they are a child.
There seems no right or wrong way to treat a perthes child but we all know from experience that most are at least restricted in any activities that cause a pounding to the femoral head and lots of doctors recommend the children keep the hip from stiffening with the use of swimming and hydrotherapy and physiotherapy. Putting a child to bed for 2yrs as they did in the 1920's is not for me or my child and thankfully this is rare. The muscle wasteage and isolation of the children is heart rendering.
I think it will be many years hence before we can compare for sure what treatment works best overall for perthes children. Until then we have to trust the doctors. I know that we were told surgery is always a last option , but necessary for some...
All the best
Sheila
: Today treatment for perthes seems to be more surgical than conservative. This may be good, but I am a firm believer of old fashioned treatments such as braces and casts before surgical intervention.Sometimes surgery may be unovoidable, but when conservative treatment might be the answer, I say reinstate it has a standard. My son had perthers in the 1960s when it was nearly all conservative treatmen. It worked for him and many others I know of. The aurgument maybe conservative methods are far longer than surgical treatment. This may be the case but the question is, is the outcome the same. My son spent nearly 10 months in a petrie cast with crosbars holding his legs a massive 47 inches apart and this worked. If in todays standards I had a child with perthes I would like the old fashiond methods still used.
: keith