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The role of coagulation abnormalities in the development of Perthes’ disease

W. D. C. Kealey, FRCS Ed, Orthopaedic Registrar1; E. E. Mayne, MD, FRCP, FRCPath, Consultant Haematologist2; W. McDonald, MPhil, FIBMS, Biomedical Service Manager2; P. Murray, FIBMS, Chief Biomedical Scientist2; and A. P. Cosgrove, MD, FRCS Orth, Consultant Orthopaedic Surgeon1

1 Department of Orthopaedic Surgery, Musgrave Park Hospital, Stockmans Lane, Belfast BT9 7JB, UK.
2 Department of Haematology, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK.

Correspondence should be sent to Mr A. P. Cosgrove at 51 Rugby Road, Belfast BT7 1PT, UK.

Recent reports have suggested an association between Perthes’ disease and an underlying thrombophilic or hypofibrinolytic tendency. In Northern Ireland there is a high incidence of Perthes’ disease (11.7 per 100 000 or 1 in 607 children) in a stable paediatric population.

We reviewed 139 children with Perthes’ disease and compared them with a control group of 220 aged- and gender-matched healthy primary schoolchildren with similar racial and ethnic backgrounds.

There were no significant deficiencies of antithrombotic factors protein C, protein S, antithrombin III or resistance to activated protein C. A total of 53 (38.1%) of the children with Perthes’ disease had a prolonged activated partial thromboplastin time (> 38) compared with 13 (5.9%) of the control group (p < 0.001). Our findings have shown that using standard assays, thrombophilia secondary to antithrombotic factor deficiency or resistance to activated protein does not appear to be an aetiological factor for Perthes’ disease. The cause of the prolonged activated partial thromboplastin time, usually associated with a clotting factor deficiency, is under further investigation.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General