Legg-Calve-Perthes Disease

Alternative Name

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

Definition

 is a childhood condition that affects the hip.. Legg-Calve-Perthes occurs when

blood supply is temporarily interrupted to the ball part of the joint. That part of the
bone then breaks more easily and heals poorly.
 Although Legg-Calve-Perthes disease can affect children of nearly any age, it's
most common among boys ages 4 to 8.

Causes

Legg-Calve-Perthes disease occurs when too little blood is supplied to the ball
portion of the hip joint (femoral head). Without an adequate blood supply, this bone
becomes unstable, and it may break easily and heal poorly.

The underlying cause of the temporary reduction in blood flow to the femoral head is still
unknown.

Symptoms

 Limping
 Pain or stiffness in the hip, groin, thigh or knee
 Limited range of motion of the hip joint
 Legg-Calve-Perthes disease usually involves just one hip, but both hips are
affected in some children.

Risk factors

 Age. Although Legg-Calve-Perthes disease can affect children of nearly any age,
it most commonly occurs between ages 4 and 8.
 Your child's sex. Legg-Calve-Perthes is up to five times more common in boys
than in girls.
 Race. White children are more likely to develop the disorder than are black
children.
  Family history. In a small number of cases, Legg-Calve-Perthes appears to run in
families.

Tests and Diagnosis

 Imaging Test
These types of tests are vital to the diagnosis of Legg-Calve-Perthes disease and
may include:
 X-rays. Initial X-rays may look normal, because it can take several weeks after
symptoms begin for the damage associated with Legg-Calve-Perthes disease to
become evident on X-rays. Your doctor may recommend several X-rays over
time, to track the progression of the bone damage.
 Bone scan. In this test, a small amount of radioactive material is injected into a
vein. The material is attracted to areas where bone is rapidly breaking down and
rebuilding itself, so these areas show up on the resulting scan images.
 Magnetic resonance imaging. This technology uses radio waves and a strong
magnetic field to produce very detailed images of bone and soft tissue inside the
body. MRIs often can visualize bone damage caused by Legg-Calve-Perthes
disease before X-rays can.

Normal Anatomy

Abnormal Anatomy of affected are

Pathophysiology
Management

A.Non-surgical Management

Treatments and drugs

The length of time required for healing will vary, depending on the severity of the bone's
damage. In most cases, treatment will last for two years or longer.

Therapy-If your child is 7 or younger and the femoral head is still fairly round, your
doctor may suggest nonsurgical treatments such as:

Exercises-As the hip stiffens, the muscles and ligaments around it may shorten.
Stretching and strengthening exercises can help keep the hip more flexible.

Crutches-In some cases, your child may need to avoid bearing weight on the affected
hip. Using crutches can help protect the joint.

Traction-If your child is in severe pain, a period of bed rest and traction may help.
Traction involves a steady and gentle pulling force on your child's leg.

Casts-To keep the femoral head deep within its socket, your doctor may recommend a
special type of leg cast that keeps both legs spread widely apart for four to six weeks.

B.Surgical Management
Nonsurgical treatments don't work as well in children older than 7, perhaps because
their bones aren't as moldable as those of younger children. Surgery may also be a
better option for children with more-severe bone deformities. Surgeries used to treat
Legg-Calve-Perthes disease include:

Contracture release- Legg-Calve-Perthes and the immobility imposed by some of its

treatments can shorten nearby muscles and tendons, which may cause the hip to pull
inward (contracture). Surgery to lengthen these tissues may help restore the hip's
flexibility.

Loose body removal- In some children, the damage to the femoral head can result in
loose bits of bone or torn flaps of cartilage. Surgically removing this misplaced tissue
can help the hip joint move more smoothly.

Hardware implants- If leg casts can't place the ball and socket in a healthy position,
your doctor might suggest changing the position of the ball and socket. This may involve
the use of metal hardware such as screws, wires or plates.
Joint realignment- If the femoral head doesn't match up well with its socket, surgeons
can alter the angle of the thighbone or the pelvis to bring the two bones into better
alignment.

C.Nursing Management

 Activity modification. Your child should avoid high-impact activities, such as

running or jumping, because they can increase the amount of damage to the
weakened bone.
 Pain medication. Over-the-counter medicines such as ibuprofen (Advil, Motrin,
others) can help relieve pain and reduce joint inflammation. Don't give your child
aspirin as it's been linked to a rare, but serious, condition called Reye's
syndrome.
 Heat or cold. Hot packs or ice may help relieve hip pain associated with Legg-
Calve-Perthes disease. Using heat before stretching exercises can help loosen
tight muscles.

Nursing Care Plan

Assessment

-Physical Examination
-Arthrography
-Venography
-MRI
-CT Scan
-Ultrasound
-SPECT Scans
-Hip X-ray

Nursing Diagnosis

-Pain
-Anxiety
-Fear
-Impaired physical mobility
-Activity intolerance
-Ineffective role performance
-Low self-esteem
-Social isolation
-Spiritual distress
-Trauma
Nursing Intervention

1.Care for the child requiring traction and spine cast.

2.Evaluate home and provide guidance to the family regarding the child’s home care.
3.Encourage family participation to the child’s care so that the members can become
familiar with details of its management.
4.Appropriate referral may include the ff:
-physical theraphy
-Social service
-Community health nurse
5.Enable the child to participate in as many normal activities of the life as possible.
6.Plans must be made for continuing education.
7.Diversion is an extremely important consideration.
8.Play should include exercise for involved extremities.
9.Special activities with peers should be arranged.
10.Provide emotional support to the child and his family because of the long-term
mature of illness.
11.Provide the family with frequent opportunities to express their feelings.
12.Point out even small indications of recovery process.
13.Introduce the family to other families with similarity affected children, if possible.
14.Range of motion exercise.
15.Bed rest.

Evaluation and Outcomes

1.Good with treatment
2.Most bone will heal with minimal deformity.
3.Manages side effects therapies.
4.Experiences no skin breakdown.
5.Demonstrates acceptance of altered body image.
6.Exhibits confidence in own abilities.
10.Verbalizes feelings.
11.Reports decreased pain.
12.Takes medications as prescribed.
13.Maintains full function of mobility.
14.Protects weakened bones.
15.Reports problems promptly.
16.Keeps follow-up health appointments.
17.Eat a balanced diet high in vit.C