الفهرس 
Introduction
Pathology of perthes’ diseaseOnly 14 pages are availabe for public view
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Abstract
Patients presenting in the later stages of Perthes’ disease with noncontainable deformities or those who have lost containment after either surgical or non-surgical containment represent a management problem. In such cases of severely affected femoral heads there is a need to rescue the head from the progressive deformity which is inevitable at this stage. The aim of this work is to compare the value and results of Chiari osteotomy versus lateral shelf acetabuloplasty in the treatment of severe cases of Perthes’ disease with deformed noncontainable femoral heads. A combined retrospective and prospective study was carried out on 25 children suffering from unilateral severe Perthes’ disease with deformed noncontainable femoral heads. All the cases were selected from the outpatient clinic of the Orthopaedic Department in the Children’s Hospital- Mansoura University. The age at the onset of symptoms ranged from 2.6 years to 11.5 years with a mean age of 7.75 ± 2.6 years. The age at surgery ranged from 5.5 years to 12.5 years with a mean age of 9 ± 1.9 years. Analysis of the pre-operative data proved that both groups were comparable concerning all the pre-operative clinical and radiological parameters. The clinical results of our patients in the Chiari group showed significant improvement as 10 out of 13 patients (76.9%) had good results according to the scoring system of Robinson et al.[147] The clinical results in the shelf group also showed significant improvement as 8 out of 12 patients (66.7%) had good results at the last follow up. No statistically significant difference was found between Chiari osteotomy and lateral shelf acetabuloplasty concerning all the investigated clinical parameters. No statistically significant difference was found between Chiari osteotomy and lateral shelf acetabuloplasty concerning sharp’s angle, percentage of acetabular cover, femoral head size ratio or the depth and height indices of the acetabulum at the last follow up. No statistically significant difference was found between Chiari osteotomy and lateral shelf acetabuloplasty concerning the total depth index measured in the immediate post-operative radiographs; however, on the last follow up, it was found significantly higher in the Chiari osteotomy group than in the shelf acetabuloplasty group.