Legg-Calve-Perthes Disease
Is the disease unilateral or bilateral?
both
Legg-CalvePerthes Disease
self limiting condition inw hich tehre is a avascaurl necrosis of the femoral head.
Patho
Necrosis results from an interruption of the blood supply to the femoral epiphysis.
Children with untreated disease or those diagnosed late in the disease process ocassionally develop what?
Osteoarthritis leg length discrepancny hip dysfunction late in life.
Once abduction is accomplished what treatment i next?
Petrie (leg abduction) casting or surgical soft tissue release such as adductor tenotomy followed by brace
Disease affects what gender ore
boys
Etiology
cogulation system disorder disturbed blood suppply to the epiphyseal plate of the femoral bone increased in families with a history of the disease mild traumatic injury
Kids with LCP tends to have what?
delayed skeletal maturation increased thyroid levels low somatomedin C (insulin-like growth faactor) common in low birth wt increased parental ae and exposure to environmental tabocacco smoke
Good prognosis consist of
femoral head can be contained long enough for proper healing to occur
What must be done to promote healing and prevent deformity of the femoral head?
femoral head must be contained within the hip socket until ossification is complete can only hapen if the hips remain in an abducted psotioin.
Clinical Therapy
made using standarnd anteroposterior and frog-leg radiograhs. Bone Scane MRI anthroography may be used tin diagnosis. Lab test: WBC (rule out inflammatory synovitis of the hip/ Protecin C, protein S and APC-R (resistance to the activated protein C) **May be done to evaluate if a coagulation abnormality is present**
LCP usually affects what gender and age?
male age 7
Would radiography taken early in the disease show anything?
no may be normal or show vague widened of the cartilage space.
What ist he desired outcome?
painfree hip that functios properly
As a school nurse how would I assess the child who complains of hip discomfort?
question about the pain assess child's ROM ask if the child injuried the hip at some time fo the past
Who wuld be the first person to observe the schild with symptoms of LCP disease?
school nurse child will have hip discomfort with a limp may complain of pain and rest at PE class
Severe disease may be treated how?
surgey to release adductor muscles, treated the acetabelum or femur and restore rang of motion
Is early detection important?
yes
/Can traction be used in early treatment?
yes maintain the hips in an abducted ad interally rotated position.
usually occurs between the ages of what?
2-12
Promote Normal Growth and Development
-Give parents suggestions to help redirect child's energy within the limitation in mobility. (horseback riding, swimming, handcrafts to promote fine motor skills, computer actities to stimulate cognitive development) -Return to school promote a feeling of NORMALITY -Facilitates with school when returning will need to use elevators, ramp - Activities that involve peers also help the child achieve developmental milestones -Help the child adjust to wearing a brace
S/S
4 Stages 1-4 years Early syptoms are Mild pain in the hip or anterior thigh and a limp are aggravated by increased activity and releived by rest Child will limi hip movements to avoid discomfort Disease progresses ROM becomes limited with weakness and muscle wasting develops Affected thigh is 2-3 cm smaller than unaffected thaigh Prolonged hip irritability may produce muscle spasms and incresed pain period of disease varies from 1-4 years Gradually resvascularization begins and pain decreases .
Community Based Care
Let the parents know that treatment usually last as long as 2 years Emphasize on follwoing the treatment plan to ensure adequate hip containment and proper healing Teach family how to care for a child in traction and skin assessemnts folwo up visits should be arranged at regular intervals in addition to home care visists during the period of traction
What brace are most commonly used?
Toronto and Scottish Rite braces
