LEGG-PERTHES DISEASE (Slipped Femoral Epiphysis; Coxa Plana) |
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LEGG-PERTHES DISEASE
(Slipped Femoral Epiphysis; Coxa Plana)
DESCRIPTIONLegg-Perthes disease is a gradual weakening of the upper end of the thigh bone where it meets the pelvis. Either leg at the hip joint (occasionally both) is involved. Legg-Perthes disease usually affects older children (5 to 11 years) of both sexes, but it is more common in boys.
Appropriate health care includes:
Physician's monitoring of general condition, medications, and treatment, including consultation with an orthopedist.
Surgery to reinforce the bone's attachment to the joint and prevent further deformity (sometimes).
Hospitalization (sometimes) for traction (a steady pull on the leg).
Home care after diagnosis or hospitalization.
SIGNS & SYMPTOMS
Pain and stiffness in the child's hip and thigh.
Pain in the leg--often the knee--even though the disorder is in the hip.
Limping.
CAUSES
Unknown. Injury is usually not a factor.
RISK FACTORS
Family history of hip disorders; use of cortisone drugs for other disorders; overweight; periods of rapid growth.
PREVENTING COMPLICATIONS OR RECURRENCEHelp an overweight child lose weight. A reducing diet appears in Appendix 31.
BASIC INFORMATION
MEDICAL TESTS
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-ray of the hip.
Special studies that may include:
-- Ultrasonography: A non-invasive technique that translates sound waves into images displayed on a screen and photographed (See Glossary).
-- CAT or CT Scan (computerized axial tomography): Non-invasive computerized X-ray images that show sections (or "slices") of an organ or region of the body clearly and precisely (See Glossary).
-- MRI (magnetic resonance imaging): A non-invasive (non-X-ray) computerized test that uses radio frequency energy and a powerful magnetic field to produce images with excellent detail (See Glossary).
-- Radionuclide Scan: A nuclear medicine procedure that uses radioactive isotopes injected into a patient. The isotope tracers are absorbed in various concentrations by targeted organs, which are then photographed (See Glossary).
POSSIBLE COMPLICATIONS
Bone infection.
Permanent damage to the thigh bone and hip joint.
PROBABLE OUTCOME
Often curable in 3 to 4 years with early treatment. Delayed treatment may cause permanent bone injury and require surgery to replace the hip.
TREATMENT
HOME CARE
Children often have difficulty accepting the need for bed rest, casts, braces, or other treatment. Enlist the help of your doctor, a counselor, a school nurse, or other significant persons, if necessary, to discuss the situation with your child.
Help your child find activities and interests that don't involve athletics.
Use heat to relieve pain. Warm compresses, heating pads, whirlpool baths, heat lamps, diathermy, and ultrasound are effective.
MEDICATION
For minor discomfort, use non-prescription drugs, such as aspirin, acetaminophen, or ibuprofen.
See Medications section for information regarding medicines your doctor may prescribe.
ACTIVITY
Bed rest may be necessary for 6 months to 1 year until the condition improves, or until after surgery. When the bones can bear weight, crutches, braces or casts are usually necessary. After that, the child may resume activities gradually. See Appendix 41, Care of Casts.
DIET & FLUIDS
No special diet, unless the child is overweight. See Appendix 31, Obesity: Guidelines for Losing Weight.
OK TO GO TO SCHOOL?Yes, when strength and feeling of well-being allows.
CALL YOUR DOCTOR IF
Your child has hip pain, knee pain, stiffness, or a limp.
The following occurs during treatment:
-- Symptoms don't improve in 4 weeks, despite treatment.
-- Pain increases.
-- Temperature rises to 101F (38.3C).
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