Legg calve perthes Disease

Secondary observation

Hip x-ray, pelvis x-ray treatment treatment

Legg Clave Perthes Disease

Idiopathic avascular necrosis of the femoral head. Inflammatory disorder with no known cause, no blood supply with dead tissue sometimes called Coxa Plana, Perthes disease.

Primary observation

Knee pain 9may be only symptom initially) persistent thigh pain, atrophy of upper thigh muscles b/c of disuse d/t pain, asymmetry in leg length, hip stiffness, limp with walking, limited ROM

Etiology

Affect children ages 3-12, most common in boys ages 4-8 usually only affects one hip, how ever 10-15% have bilateral hip involvement. Most affected children have delayed bone age, may last 18 months - several years

Prognosis

outcome is good with tx the earlier it is dx and tx is begun the more favorable the outcome. Osteoarthritis may develop later in life.

Psychosocial concerns

Difficult to treat due to child's normal desire for activity at this age. Child feels well, but must have activity limited, good time for children to begin a hobby.

TX

Goal: to contain the head of femur in the acetabulum and to protect bone and joint from further stress and injury while healing process takes place. Conservative Rx can take 2-4 years=bedrest and non-weigh bearing initially, brace, cast, traction or splint to immobilize hip bone re-growth takes place. ( most don't choose this option) Surgical Rx-decreases immobile time to 3-4 months however has more risk (infection, blood loss, anesthesia, etc..) Age where developmental task need met. More appealing but more risk.

Patho

Stage 1- Avascular Stage-aseptic necrosis or infarction of the femoral capital epiphysis with degenerative changes producing flattening of the upper surface of the femoral head Stage 2- Fragmentation revascularization stage-beginning of healing Capital bone absorption and revascularization with fragmentation (vascular resorption of the epiphysis) Stage 3 Reparative Stage- New bone formation-fills in from the periphery to the central part of the head of femur. Stage 4- Regenerative Stage-gradual reformation of the head of the femur ***must keep immobile during stages