JOHN BEHROOZ GOMEZ

Legg-Calve-Perthes disease - A hip disorder in children due to interruption of the blood supply to the head of the femur (the ball in the ball-andsocket hip joint), causing it to deteriorate. this disease is most common at age 6 to 9, tends to affect boys, but is more severe in girls. It can be familial Legg-Calve-Perthes disease is when the ball of the thighbone in the hip doesn't get enough blood, causing the bone to die.

Etiology The blood flow of the femur is interrupted, and the tip of the bone dies over a period of one to three weeks. The disorder causes a flattening of the top of the femur (the ball of the head of the femur). Usually one hip is affected, although its possible for both to develop the condition. The disorder may reflect subtle disorders of blood clothing.

Pathophysiology

Cause of LPD is insufficient blood supply to the femoral head

Epiphyseal plate and the ligamentum vessels become non-functional

Resulting in flattening and collapse of the femoral head

Osteonecrosis

Sign and symptoms 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 1. 2. 3. 4. 5. 6. 7. Knee pain Persistent thigh or groin pain Atrophy of muscles in the upper thigh Slight shortening of the leg, or legs of unequal length. Hip stiffness restricting movement in the hip. Difficulty walking, walking with limp Limited range of motion Limited abduction and internal rotation of the hip. Mild to moderate muscle spasm. Deformity and flattening of femoral head Lateral overgrowth of the femoral head cartilage. Progressive loss of movement Abduction contractures Diagnostic procedure Physical examination Arthrography Venography MRI CT scan Ultrasound Hip X-ray Medical management Anti-inflammatory medications. Over-the-counter medications such as ibuprofen (Advil, Motrin, others) can help relieve pain. They can also reduce joint inflammation when used for months at a time. The dosage may be decreased as your child's hip begins to heal. Although it is an anti-inflammatory medication, aspirin isn't recommended for use in children. Physical therapy. Range-of-motion exercises can help maintain joint mobility. These exercises can be done at home or with the help of a physical therapist. Crutches. Crutches can ease pain by keeping your child's weight off his or her hip. Casts, braces or traction. Temporarily immobilizing the bone can help promote healing. This may be done with leg or hip casts, leg braces or traction (applying a pulling force to the bone). Surgery. If a groin muscle has shortened due to excessive limping, it may be surgically released from the bone. After surgery, the affected leg is put in a cast for six to eight weeks to allow the muscle to grow to a more normal length. Sometimes the hip ball must be replaced within the socket. In other cases, the hip socket is repositioned.

Surgical management Osteotomy

Nursing management 1. 2. 3. Evaluate home and provide guidance to the family regarding the childs home care. Encourage family participation to the childs care so that members can become familiar with details of its management. Enable the child to participate as many normal activities of life as possible.

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Plans must be made for continuing education. Provide diversional activities. Play should include exercise for involved extremities. Special activities with peers should be arranged. Provide emotional support to the child and his family because of the long term mature of illness. Provide the family with frequent opportunities to express their feeling. Point out even small indications for recovery process. Encourage range of motion exercises. Provide bed rest to conserve energy.

Poliomyelitis - is an acute infectious disease caused by any of the three types of Poliomyelitis virus which affects chiefly the anterior horn cells of the Spinal cord and the medulla, cerebellum and midbrain. - Characterized by two febrile episodes, a minor and major illness separated by a remission of one or two days followed by varying degrees of muscle weakness or occasionally a progressive Paralysis that ends fatally. SYNONYMS: Acute Anterior Poliomyelitis; Heine-Medin Disease: Infantile Paralysis. ETIOLOGY AND EPIDEMIOLOGY: - the causative virus is poliovirus (Legio Debilitants) - there are 3 distinct serelogic types of poliovirus (with no cross Immunity) 1) Type I is the most paralytogenic or the most frequent cause of Paralytic poliomyelitis, both epidemic and endemic. 2) Type II the next most frequent. 3) Type III the least frequently associated with paralytic disease. Types of Poliomyelitis 1) Spinal Cervical Thoracic Lumbar 2) Bulbar Cranial nerves Circular System Respiratory System 3) Bulbo-spinal 4) Polioencephalitis

Pathophysiology

Ingestion of legio debilitants through oral faecal route Enters the body through alimentary tract, multiplies in the oropharynx Proceeds to the intestine where the organism lodge and multiply The organism spread to the regional lymph nodes and the blood stream The organism spread to the regional lymph nodes and the blood stream The organisms migrate to the central nervous system Subsequent congestion occurs, edema and necrosis NEURAL PHASE

INTESTINAL PHASE

VIREMIC PHASE

Lesions are found mainly at the anterior horn cells Muscle spasms and paresis or paralysis is evident

Sing and symptoms General discomfort or uneasiness (malaise) Headache Red throat Slight fever Sore throat

Vomiting

NONPARALYTIC POLIOMYELITIS Back pain or backache Diarrhea Excessive tiredness, fatigue Headache Irritability Leg pain (calf muscles) Moderate fever Muscle stiffness Muscle tenderness and spasm in any area of the body Neck pain and stiffness Pain in front part of neck Pain or stiffness of the back, arms, legs, abdomen Skin rash or lesion with pain Vomiting PARALYTIC POLIOMYELITIS Fever 5 - 7 days before other symptoms Abnormal sensations (but not loss of sensation) in an area Bloated feeling in abdomen Breathing difficulty Constipation Difficulty beginning to urinate Drooling Headache Irritability or poor temper control Muscle contractions or muscle spasms in the calf, neck, or back Muscle pain Muscle weakness that is only on one side or worse on one side o Comes on quickly o Location depends on where the spinal cord is affected o Worsens into paralysis Sensitivity to touch; mild touch may be painful Stiff neck and back Swallowing difficulty Medical and Nursing Management a. medication and treatment 1. Analgesic- for relieving pain 2. Antipyretic- to relieve fever Polio Vaccine 1. Salk Vaccine

2. Sabin VaccineSurgical management a. Muscle and tendon transplantation Operation of Tendons 1. tenotomy 2. myotomy 3. fasciotomy. b. Arthrodesis- fusion of bones across a joint space by surgical means, which eliminates movement, usually performed to eliminate pain over a joint. c. Osteotomy- cutting of bone into 2 parts followed by realignment of ends to allow healing d. Operation to equalized the leg length discrepancy After poliomyelitis, growth affected leg is slowed down as much 6 to 7 cm by disuse, atrophy and diminished blood flow to the limb. The degree of shortening depends of the severity of the paralysis and the age at which paralysis begins. Nursing management Maintain a patent airway, and keep a tracheotomy tray at the patients bed side. Encourage a return to mild activity as soon as possible. Prevent fecal impaction by giving enough fluids to ensure an adequate daily urine output of low specific gravity. Provide tube feedings when needed. Provide good skin care, reposition the patient often, and keep bed linens dry. To alleviate discomforts, use foam rubber pads and sandbags or light splints as ordered. Wash hands thoroughly after contact with the patient or any of his secretions and excretions. Frequently check blood pressure, especially if the patient has bulbar poliomyelitis. Assess bladder retention that cause muscle paralysis. Have the patient wear high-top sneakers or use a footboard to prevent foot drop. Provide emotional support to the patient and his family.

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