Professional Documents
Culture Documents
I. Definition
Legg-Calve-Perthes disease is when the head of the thighbone (femur) in
the hip deteriorates due to insufficient blood supply to the area.
III. Incidences
• United States
One in 1200 children younger than 15 years is affected by LCPD.
• Race
Caucasians are affected more frequently than persons of other
races.
• Sex
Males are affected 4-5 times more often than females.
• Age
LCPD most commonly is seen in persons aged 3-12 years, with a
median age of 7 years.
• Stage I (avascularity)
• Stage II (revascularization)
New blood vessels arise to supply the necrotic area, and bone
resorption and deposition take place (lasts everal months to 1 year)
However the new bone lacks strength and pathologic fractures may occur;
the weakened epiphysis may be progressively deformed
• Stage IV (postrecovery)
(1) Initial - histological evidence of dead bone with disappearance of osteocytes from
empty lacunae
(3) early intermediate - active resorption of dead bone along with new bone deposits
(4) late intermediate- decreased bone resorption and increasing immature bone
formation
The newly healed epiphysis may be left with residual deformity and never regain a
totally normal shape and appearance. Residual deformity can lead to serious disability
later in life.Some flattening of the epiphysis, referred to as “coxa plana,” can occur. In
more severe disease, complete collapse can occur, with the femoral head mushrooming
around the femoral neck. Because younger patients have more growth potential for
reformation and remodeling of bone, they tend to have better outcomes.
• Laboratory Studies
Laboratory studies for Legg-Calv é -Perthes disease include the
following:
CBC
Erythrocyte sedimentation rate - May be elevated if infection
present
• Imaging Studies
Plain x-rays of the hip are extremely useful in establishing the
diagnosis.
Frog leg views of the affected hip are very helpful.
Multiple radiographic classification systems exist, based on the
extent of abnormality of the capital femoral epiphysis.
o Waldenstrom, Catterall, Salter and Thompson, and
Herring are the 4 most common classification systems.
o No agreement has been reached as to the best
classification system.
Five radiographic stages can be seen by plain x-ray. In
sequence, they are as follows:
o Cessation of growth at the capital femoral epiphysis;
smaller femoral head epiphysis and widening of articular
space on affected side
o Subchondral fracture; linear radiolucency within the
femoral head epiphysis
o Resorption of bone
o Re-ossification of new bone
o Healed stage
Technetium 99 bone scan - Helpful in delineating the extent of
avascular changes before they are evident on plain radiographs
Dynamic arthrography - Assesses sphericity of the head of the
femur
• Procedures
Hip aspiration if a septic joint is suspected
IX. Management
• Medical
Monitoring
• Surgical
X. Nursing Diagnosis
1. Acute Pain
2. Bathing or Self-Care Deficit
3. Impaired Physical Mobility
4. Disturbed Body Image
5. Ineffective Therapeutic Regimen Management
Preoperative Management
1. Assess nutritional status; hydration, protein and caloric intake. Maximize healing
and reduce risk of complications by providing I.V. fluids, vitamins and nutritional
supplements as indicated.
3. Determine if the patient has an infection (cold, dental, skin, UTI); it could
contribute to development of osteomyelitis after surgery. Administer preoperative
antibiotics as ordered.
4. Prepare patient for postoperative routines, w/c include coughing and deep
breathing, frequent v/s and wound checks and repositioning.
5. Have the patient practice voiding on bed pan or urinal in recumbent position
before surgery. This helps reduce the need for post operative catheterization.
6. Acquaint the patient with traction apparatus and the need for splint or cast, as
indicated by the type of surgery.
1. Monitor for hemorrhage and shock, which may result from significant bleeding
and poor hemostasis of muscles that occur with orthopedic surgery.
a. Evaluate the blood pressure and pulse rates frequently – report rising
pulse rate or slowly decreasing blood pressure.
a. Watch circulation distal to the part where cast, bandage, or splint has been
applied; check pulses, color, warmth, and capillary refill.
6. Immobilize the affected area and limit activity to protect the operative site and
stabilize musculoskeletal structures.
8. Change position and encourage use of incentive spirometer and coughing and
deep-breathing exercises every 2 hours to mobilize secretions and prevent
atelectasis. Auscultate lungs frequently.
9. Monitor v/s for fever, tachycardia, or increased respiratory rate, which may
indicate infection.
10. Maintain aseptic technique for dressing changes and wound care.
11. Encourage the patient to move joints that are not fixed by traction or appliance
through their range of motion as fully as possible. Suggest muscle-setting
exercises (quadriceps setting) if active motion is contraindicated.
15. Avoid giving calcium supplements patients on bed rest, and encourage other
fluids to prevent other fluids to prevent urinary calculi.
XII. Illustrations