Perthes' disease. Treatment with the Birmingham splint.

“To treat or not to treat?” has remained the central question ever since Perthes’ disease was first described 70 years ago. Which is the best treatment and to whom it should be applied, remains the next important question for all except therapeutic nihilists. As the disease is relatively uncommon, most reports are on few patients and have generally struck a favourable note. In 1 960 a special clinic for children suffering from Perthes’ disease was established at the Royal Orthopaedic Hospital, Birmingham. This has enabled one team to gain a large experience and we now report the results of conservative treatment in 213 children. The splint used (Figs 1 , 2 and 3) was designed at the Royal Orthopaedic Hospital and described in a previous article (Harrison, Turner and Nicholson 1 969). The conceptual basis for this treatment is that the deformation of the femoral head in Perthes’ disease follows unequal loading of the infarcted epiphysis; part of the head lies within the acetabulum and carries load, part is outside the acetabulum and is not under load. If the capital epiphysis is completely contained within the acetabulum (by flexion, abduction and medial rotation) loading is equalised and deformation is prevented. That this position achieves such containment can be demonstrated by post-mortem examination of a child’s hip and confirmed by computer-assisted tomography.