[Bed rest and skin traction for Perthes' disease: review of the literature].
Long-term bed rest with skin traction, which isolates children with Perthes' disease from their social and educative environment, could be considered as incompatible with the ethics of modern therapeutics. Adaptation for home care has been proposed, but remains burdensome. We searched the literature in order to ascertain the real advantages and disadvantages of bed rest with skin traction and to evaluate the statistical value of published results. Considering that poor outcome is the natural course of the disease in 10-20% of patients, and that the number of patients in this group is further divided according to age and treatment, the number of patients in each treatment arm is rarely sufficient to validate any given treatment. For hips with limited abduction, traction does not appear to be warranted. Conversely, traction could be useful if the aim is to modify the natural course of the disease in precise situations, for example for Herring group B and or B/C patients with bone age above 6 years with a stiff hip. In this case, skin traction should not last more than two weeks and, to be considered useful, should achieve 30 degrees abduction documented on the ap view.
Leclerc
J
J
Service de Chirurgie Infantile, CHD F. Guyon, 97405 Saint-Denis, île de La Réunion.
Laville
J-M
JM
Salmeron
F
F
D001510:Bed Rest; D006801:Humans; D007873:Legg-Calve-Perthes Disease / Q000628:therapy*; D013997:Time Factors; D014143:Traction / Q000379:methods