Perthes' disease after poliomyelitis. Recognition and management of aseptic capital femoral necrosis.

Aseptic necrosis of the capital femoral epiphysis occurred in a polio-wasted leg and was undiagnosed for over one year. The diagnosis was overlooked because of a pre-existent limp. Exacerbation of an existent limp or persistent knee or leg pain should always prompt a thorough search to exclude chronic and acute causes of hip disease in young children. Aggressive and individualized care is indicated for Perthes' disease and may include non-surgical means such as recumbency and bracing in the very young or traction with abduction and various bracings in the older children. Surgical approaches may include femoral and/or pelvic osteotomies in a variety of approaches. Older children may refuse treatment and those with milder femoral head involvement may recover with minimal head asymmetry. Early and appropriate management is generally successful in avoiding deformity.