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Sclerosis & irregularity of femrol head in child


Kaput

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Probably a long shot, has anyone's child had sclerosis and irregularities of the femoral head? Has anyone been through this?


Mr4 had to have xrays earlier this week, turned out to be swelling under his knee cap, But the xrays showed sclerosis and irregularities of the femoral head on his left side. His xrays from last year of his right femoral head after he broke his femur showed the same sclerosis and irregularities, as in some of the bone is missing. He was referred to orthopaedics at the larger public hospital. They called and wanted to see him quickly, which feels ominous. We have an appointment on Wednesday.


The only things coming up seem to be a one off trauma where the bone will regrow, though he'll need to be physically carefully for a year or two while the bone recovers, can't see that happening (Eta can't see the being physically carefully). Or a degenerative disease.


Ed cause it was very long.

Edited by Behind Hazel Eyes
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Thanks @kadoodle. Legg Perthes Disease seems like the most likely. Good long term prognosis but no high impact movement allowed for a long time, circa 2 years. No jumping, bouncing or running, going to be interesting trying to get the probably has ADHD kid to sit still more. They can swim though, so if that's it I'll get a pool membership and swim lessons. Potentially regular physio hopefully at the nearer rehab hospital than the big public one and semi regular xrays to track it. Everything that pops up says early detection improves outcomes and he's not limping or in constant pain which is usually when it's diagnosed. Might have been a lucky break getting that swollen knee 😅.

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I was going to ask if it was likely to be Perthes.


My brother was diagnosed with Perthes nearly 40 years ago at the age of 5 after having a sore knee. At the same time, there was one other boy & girl in our very small town also diagnosed. None of the families involved were socio-economically challenged.


I'm sure the treatment has advanced since then but I can tell you what he had, if you are interested? He was first put in groin to ankle plaster on both legs with a bar in between, about mid-calf height. I guess to get the optimal angles for his hips and also to try and immobilise them. After a period of time, he went onto a plastic and aluminium frame set of calipers which pretty much mimicked the plaster cast but not as heavy & could wear clothes underneath. From memory, he wore these for maybe 3 years. I remember him having muscle pain with lots of massage and hot water bottles applied.


I do have to say though, that it didn't seem to slow him down. He still played rugby and softball, went on the trampoline & slide, and did cross country with his legs spread-eagled & somehow managing to swing his legs & torso while running. Now as a parent, I imagine he must have been a bloody nightmare. Trying to keep him still and not doing the high-impact stuff mentioned above as well as all of the normal hygiene aspects would have been tough.


As a teenager, he continued playing sport to a reasonable level although his hips deteriorated over time. He was supposed to get both hips replaced at 20 but chose to ride it out for as long as possible as he was told the longevity of replacement being only 20 years.


He had a full single hip replacement 2 years ago with the remaining one still in really bad condition & also needing to be replaced.


There is some suggestion that there may be an auto-immunity correlation with Perthes. My brother has, in the last 8 years, been diagnosed with Crohns Disease. It is pretty uncontrolled & severe currently. At this stage, they don't know if it was evident in him as a child or if it is related to his Perthes.


Good luck next week. I hope it all goes well for you.

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Guest BusbyWilkes

Interestingly, the 2 boys we know who had Perthes both also have ADHD.

It was difficult to keep them still while younger but as teens now have no ongoing issues.

Fingers crossed it’s something insignificant and easily treated - you don’t need anything else to have to juggle.

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Wrote a big post yesterday and lost it. Thanks BusbyWilkes. That's good to know. Will have to find a way to muddle through whatever it is. Maybe it's all the jumping and never being still that does it. They don't know what causes perthes. But I'm hoping it's that as it seems the best outcome wise.


Thanks Emembee. I've found some more recent information and depending on severity we're probably looking at either no high impact activities and minimal physical activity or being confined to a wheel chair most of the time for 2 years. If it is that. Sounds like your brother was on the more severe side. The prognosis seems fairly good these days.


I was kinda hoping it was a result of his broken leg last year when it was first mentioned. But he's had it at least a year and there's some amount of bone death involved so I expect it won't be life as usual come Wednesday. Perthes seems to be the best option of what it could be. Still hoping I overlooked something minor and easily treatable.

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I pulled out mr4 discharge after his broken femur last year. Right at the end it mentions the femoral head irregularities on the right side and asks if there's a prior history of Perthes. Can't remember if I read it, I was struggling to cope with how much pain I was in after his 2 weeks in hospital during lockdown. Though I doubt it would have meant anything if I had read it. They never spoke to us about it at all. Not sure if that's good if they thought he had Perthes in the past and was in recovery or what.

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I've taught a few boys with Perthes. Varying forms of casting / bracing that looked pretty awful, but the boys managed to still get about okay and rejected wheelchairs in both cases. Needed some adaptations in the classroom with seating etc. and toilet access. Worth it in the long run to aid proper bone development.

The boys I knew were both between 6 to 8 years old at the time.


Good luck.

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Thanks [mention]Jerry[/mention]. Were they able to play at lunch time as normal and do PE? Some stuff I read spoke of having to stay inside at playtime? I mentioned it to his preschool (year before fyos here) teacher more to ask if she'd noticed anything. Planning to email her and the SN Coordinator whose also the deputy if anything concrete comes out of Wednesday appointment. Between Ms8 anxiety, mr6 Autism and developmental delays and mr4 developmental delays I've had a lot of contact with the deputy principal. In her role as SN Coordinator.

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The boys I know of with Perthes both went out at break times to play. I remember one of them acted as goalie in soccer games, as running about would have been (almost) impossible in the brace he had: it was kind of like a stick holding legs far apart, with bracing at the thighs. He was a good goalie. ;)

The other boy was in a wheelchair for about two weeks while he got used to things. He had had a few weeks in hospital in traction if I remember correctly.. He also got about just fine but I would by lying if I said the play wasn't restricted.

Both boys were country boys so took on challenges pretty well.


Also my experiences were 15 years ago, so I am sure treatment has progressed since then.

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He's got perthes. There's no one at Canberra Hospital that can deal with it, they're seeing if the paediatric orthopaedic specialist who comes down once a month has space to see him. Otherwise it'll be regular trips to Sydney childrens hospital for monitoring. None of the doctors here know enough to tell us more than the basics. Reduction of high impact activities, monitoring and while the prognosis is most likely good long term they have no idea at this stage if he'll recover or not.

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So sorry to hear of the diagnosis. It's hard getting life changing news.

Hopefully you'll find out soon what the treatment will be. As I said, I've seen boys go through it and they are more resilient that we think they are. My little guy was out playing soccer after a while. Sometimes it is hospitalisation for a bit first then wheelchair then the braces. Looks awful but they get used to it pretty quickly.


Funny timing, I now have a parent contact school today saying their boy is in hospital immobilised due to hip condition being diagnosed. My money is on Perthes for him too - right age, right symptoms.


Hope smooth sailing ahead with the treatment. Best wishes.

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  • 2 weeks later...

Hi [mention]Behind Hazel Eyes[/mention] - I just saw your "Just want to put this somewhere" post and followed your posts back to this thread. I was a kid with Perthe's disease, I was unusual because I was considered old (nearly 7 and I think back then it was considered for 5-6 year olds) and a girl.


I developed a left leg limp towards the end of 1982, I was finishing Grade 1 in Victoria. Mum figured I was tired at the end of the year and had sprained a muscle/ligament. It didn't get better over the summer holidays and just before school started she took me to the GP, I was x-rayed, saw an paediatric orthopaedic specialist and was hospitalised by lunchtime with a diagnosis.


Operating was a brand new treatment at the time, so my parents opted for the slow and steady approach - I spent the best part of my Grade 2 year in traction at home in bed - legs bandaged attached to weights over the end of the bed, to allow the ball of my femur to regenerate. My new room was the lounge so I would be part of family life. During Grade 3 I learned to use crutches and I could start using my right leg again, left was still out of action. I remember I went to Grade 4 camp at the start of the camp still on crutches, and some time that year I went to a walking frame and then walking again by the start of Grade 5. So it took around two years out of my life, long at the time but short from the perspective of a nearly 45 year old!


There were many challenges, particularly for mum who did most of the caring, my brothers who missed out a bit of normal family life and dad who carried the financial burden as mum gave up work, Some bits were tough and unfair but as a kid but mostly I accepted it was what it was. Kids are resilient like that. I became really good at amusing myself - correspondence schooling and brownie guides, reading, cooking, various craft projects, lots of probably not so appropriate daytime and evening TV (Mum and I would usually partake in Days of our lives over lunch). I experienced the stares of being someone with an obvious disability. The primary school principal didn't want to accept a kid in a wheelchair (lucky he didn't win that one, I went on to become dux of year 12). Learning to walk again was hard work. But I was otherwise healthy, and remain so. I have had some minor issues with left leg weakness - regularly rolling left ankles in high school, dislocating left knees in uni but had two babies in my 30s without any issues. No hip issues and I'm not expecting any. I've never had any pain.


The experience had a huge impact on my childhood and influenced who I am today, but I think for the better not the worse. Please reach out to others with more recent experiences with Perthe's and I'm sure you will find advice and support. All the best to you and your little boy, you will both be stronger than you know and come through the other side.


https://www.facebook.com/Perthes-Disease-Support-Group-Aust-160629390660298/


https://pertheskids.org.au/

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