A Possible Early Sign of Perthes' Disease

The illustration is a print from a contact transparency taken from a radiograph of a child age nine years. The radiograph was taken when the patient complained of pain three weeks after a fall on the right hip. The case was recognised clinically as possibly one of Perthes' disease and treated accordingly. Subsequent radiographs proved this to be correct; the classical picture of Perthes' disease developed. The only definite abnormality to be detected in this film is the convexity of the upper border of the neck of the right femur on comparison with the left, which is practically straight. The difference is measurable and it persisted throughout the series of radiographs taken of this case. The same convexity is present in the films and illustrations of over thirty cases of Perthes' disease that have been examined. In addition, over 250 films which were taken for other than possible bone lesions in this region have been scrutinised, but no similar unilateral convexity was found—with one exception, but, unfortunately, although several attempts were made, this child could not be traced. The examination was not a recent one and was of a hospital patient from a poor and populous neighbourhood and the search had to be abandoned.