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    Legg Calve Perthes

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    Nelhbenson Laurente
    Legg Calve Perthes (LCPD) is a degenerative disease of the hip joint typically found in young children where loss of blood supply to the femoral head leads to bone death and collapse of the hip joint. It causes deformity of the femoral ball and socket and can lead to osteoarthritis in adulthood. The disease involves four stages where the femoral head becomes denser and fragments before reossifying. Treatment focuses on reducing pain and restoring mobility through medical management like NSAIDs or surgery.

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    Legg Calve Perthes

    Uploaded by

    Nelhbenson Laurente
    489 views7 pages
    Legg Calve Perthes (LCPD) is a degenerative disease of the hip joint typically found in young children where loss of blood supply to the femoral head leads to bone death and collapse of the hip joint. It causes deformity of the femoral ball and socket and can lead to osteoarthritis in adulthood. The disease involves four stages where the femoral head becomes denser and fragments before reossifying. Treatment focuses on reducing pain and restoring mobility through medical management like NSAIDs or surgery.

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    Legg Calve Perthes (LCPD) is a degenerative disease of the hip joint typically found in young children where loss of blood supply to the femoral head leads to bone death and collapse of the hip joint. It causes deformity of the femoral ball and socket and can lead to osteoarthritis in adulthood. The disease involves four stages where the femoral head becomes denser and fragments before reossifying. Treatment focuses on reducing pain and restoring mobility through medical management like NSAIDs or surgery.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    489 views7 pages

    Legg Calve Perthes

    Uploaded by

    Nelhbenson Laurente
    Legg Calve Perthes (LCPD) is a degenerative disease of the hip joint typically found in young children where loss of blood supply to the femoral head leads to bone death and collapse of the hip joint. It causes deformity of the femoral ball and socket and can lead to osteoarthritis in adulthood. The disease involves four stages where the femoral head becomes denser and fragments before reossifying. Treatment focuses on reducing pain and restoring mobility through medical management like NSAIDs or surgery.

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    The key takeaways are that Legg Calve Perthes disease is a degenerative disease of the hip joint that typically affects young children and can lead to osteoarthritis in adults. It results from reduced blood flow to the femoral head. Avascular necrosis is bone death due to loss of blood supply and can lead to joint collapse.

    The four stages of Legg Calve Perthes disease are: 1) increased bone density and possible fracture, 2) bone fragmentation and reabsorption, 3) reossification as new bone regrows, and 4) healing and reshaping of new bone.

    Diagnostic tests for avascular necrosis include x-rays, MRI, bone scintigraphy, CT scan, and bone biopsy.

    Legg Calve Perthes (LCPD)

    Is a degenerative disease of the hip joint, where growth/loss


    of bone mass leads to some degree of collapse of the hip joint and
    to deformity of the ball of the femur and the surface of the hip
    socket. The disease is characterized by idiopathic avascular
    osteonecrosis of the capital femoral epiphysis of the femoral head
    leading to an interruption of the blood supply of the head of the
    femur close to the hip joint. The disease is typically found in young
    children, and it can lead to osteoarthritis in adults. The effects of
    the disease can sometimes continue into adulthood.

    Also known as:

     Perthes disease
     Ischemic necrosis of the hip
     Coxa plana
     Osteochondritis
     Vascular necrosis of the femoral head

    Causes:

     The exact cause is unknown


     Reduction in blood flow to the joint
     It is thought that the artery of the ligamentum teres femoris
    closes too early, not allowing time for the medical circumflex
    femoral artery to take over
     Abnormal blood clotting
     Infection
     Malnourishment
     Genetic
     Trauma

    Incidence

    Perthes is rare, occurring in approximately 5.5 of 100,000 children.

    Signs & Symptoms:

    First Signs:
     complaint of sourness from the child (often dismissed
    as growing pain)
     limping
     guarding of the joint
    Other Symptoms:
     hip, knee (reffered pain), or groin pain, exacerbated
    by hip/leg movement.
     Reduce ROM at the hip joint and a painful or antalgic
    gait
     Atrophy of thigh muscles from disuse
     Inequality of the leg length.

    Pathophysiology

    Predisposing/ Risk factors:


     Obesity
     Family history
     Low birth weight
     Abnormal presentation at birth
     Race- Asians, Eskimos, whites

    Genetic, Infection, Trauma, Malnutrition, Abnormal Blood Clotting,


    Idiopathic.

    Rapid Growth > Development of the Supply of the Secondary Ossification


    Centers in the Epiphysis.

    Interrupted of adequate blood flow

    Prone to avascular necrosis

    Result in necrosis

    Deformity of the ball of the hip, knee or groin


    pain
    femur and the surface of the
    hip socket
    Limping, guarding of
    the joint
    inequality of leg length

    antalgic gait

    Disuse
    Atrophy thigh muscles

    Four Stages of LCPD

    1. Femoral head becomes more dense with possible fracture


    of supporting bone;
    2. Fragmentation and reabsorption of bone;
    3. Reossification when new bone has regrown; and
    4. Healing, when new bone reshapes.

    Phase I takes about 6-2 months, Phase 2 takes one year or


    more, and Phase 3 and 4 may go on for many years.

    Diagnosis:
     X-Ray
     Magnetic Resonance Imaging (MRI)
     bone scan

    Treatment

    The goal of treatment is four-fold:


    I) to reduce hip irritability
    2) restore and maintain hip mobility
    3) to prevent the ball from extruding or collapsing
    4) to regain a spherical femoral head

    Medical MGT:

     NSAID (Motrin) – for pain


     Zoledponic Acid (under investigation)

    Surgical MGT:

    Surgery is indicated for children greater that age 6 years.

     Excision of extruded portion of the head for hinge abduction


     Acetabular osteotomy
     Lateral shelf osteotomy
     Chiari osteotomy
     Valgus osteotomy
     Arthrodesis

    Non-surgical treatment:

     cast
     traction
     braces
    Prevention

    There is no known effective preventative measure

    Nursing MGT:

     Distraction method – for pain


     Advice refrains from contacts sports or game/activities which
    impact the pain.

    General Interventions:

    1. Instruct patient to report pain as soon as it begins


    2. Provide quite environment, calm activities.
    3. Encourage use of diversional activity (TV, Radio,
    socializing)
    4. Encourage adequate rest periods to prevent fatigue
    evaluate in pain behavior

    Nursing Dx:

     Acute pain related to inflammation of joint secondary to legg


    calve perthes disease.
     Impaired physical mobility related to abnormal gait secondary
    to legg calve perthes disease.
     Risk for injury related to altered mobility secondary to
    unsteady gait.
    Avascular Necrosis

    Is a disease resulting from the temporary or permanent loss


    of the blood supply to the bone. Without blood, the bone tissue dies
    and causes the bone to collapse. If the process involves the bones
    near a joint, it often leads to collapse of the joint surface.

    Also known as:

     Osteonecrosis
     Aseptic necrosis
     Ischemic bone necrosis

    Etiologies:

     Alcohol abuse
     Caisson (decompression) disease
     Cigarette smoking
     Fat emboli
     Gout
     Radiation therapy
     Raynauld phenomenon
     Sickle cell disease with increase blood viscosity
     Systemic steroids
     Trauma, such as fracture, disruption circulation in the bone
     Unknown cause, known as idiopathic AVN

    Causes:

    Following is a list of causes or underlying conditions (see also


    Misdiagnosis of underlying causes of Avascular necrosis) that could
    possibly cause Avascular necrosis includes:

     Traumatic injury
     Fracture
     Dislocation
     Dislocated hip (see Hip symptoms)
     Alcoholism
     Excessive alcohol
    Pathophysiology

    Risk factors:

     injury
     steroid use
     Gaucher disease
     alcohol use
     blood disorders, such as sickle cell anemia
     radiation treatments
     chemotherapy
     pancreatitis
     decompression disease

    Traumatic causes non-traumatic causes

    Temporary or permanent loss of blood supply to the bone

    When blood supply is cut off, the bone tissue dies


     minimal early joint pain

    Bone collapses
     increased joint pain as bone and joint begin to collapse

    If it occurs near a joint, collapse of the joint surface may occur


     limited range of motion due to pain

    Diagnostic Tests

    The list of diagnostic tests mentioned in various sources as used


    in the diagnosis of Avascular necrosis includes:

     X-rays
     MRI - good for diagnosis in the early stages
     Bone scintigraphy (bone scan)
     CT scan
     Bone biopsy

    Treatments for Avascular necrosis

    The list of treatments mentioned in various sources for Avascular


    necrosis includes the following list. Always seek professional medical
    advice about any treatment or change in treatment plans.
     NSAIDs - for pain
     Avoid weight bearing - take pressure off the joint (e.g.
    crutches); in some cases this allows the body to self-heal.
     Range-of-motion exercises
     Electrical stimulation - to stimulate natural growth of the
    bone.
     Avoid alcohol
     Treat alcoholism - if the problem is caused by alcoholism.
     Discontinue corticosteroid use - slowly under medical advice,
    since stopping quickly causes problems.
     Surgical treatments
    o Core decompression
    o Osteotomy
    o Bone graft
    o Joint replacement (arthroplasty)

    Nursing Dx:

     Impair physical mobility related to AVN of femoral head or


    tarsal navicular bone.
     Acute pain related to ischemic changes and degeneration of
    involved bone.

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