Legg-Calve-Perthes Disease
Legg-Calve-Perthes Disease
Legg-Calve-Perthes Disease (a.k.a. Osteonecrosis) is a rare, temporary condition only found in children ages 4 to 12, with the average of 6 years old. In an infected child, the femoral head loses its blood supply; bone begins to die and over time may develop a fracture. The bone then begins to slowly reabsorb and it is replaced with new tissue and bone. This can be very painful for child and can take many years to correct. The disease only occurs in one hip a majority if the time.
There are four stages of LCPD. In the first stage, the femoral head loses its blood supply, bone dies and it could possibly become fractured. During the second stage, the body starts to replace the dead bone; which can take up to 3 years. Throughout the third and fourth stages, the femoral head continues to grow and form its round, spherical shape. This rebuilding process can take many years to finish. The cause of this disease is unknown and more likely to affect children that are very active, athletic and small for their age (Dezateux & Roposch pg.1464). Boys are four times more susceptible to the disease than girls. Risks are also higher for Asians, Eskimos and Whites. Second hand smoke raises those risks.
Symptoms include children developing a limp during activity, as well as complaining of pain in the hip, groin, and knee area. Sometimes children can’t exactly pinpoint where they hurt, if they experience pain at all. In some cases, a child will get injured during playing, go to the doctor’s and a radiograph will uncover the non-diagnosed disease. Legg-Calve-Perthes disease can also resemble many other medical conditions.
In addition to a complete medical history and physical exam, the patient will have to undergo supplementary procedures in order to properly diagnosis the disease. Radiographs of the pelvis and hips, which include AP pelvis, center 2” above symphysis pubis (technique shows the femoral heads through the acetabulum). AP hip and axiolateral, both centered to the femoral neck of the affected hip (technique should also show the femoral head through the acetabulum). Anatomy included on these radiographs is the adjoining region of the ileum to the proximal 1/3 of the femur (Bontrager & Lampignano pg.272). If diagnosed with LCPD, the appearance of the anatomy in the radiographs would have flattened or fragmented femoral head or heads. When taking these radiographs, the child should be exposed to smaller doses of radiation due to his, or her, size. If a child is being uncooperative, shortening your exposure time will reduce the risk of motion not requiring you to repeat the radiographs. This will also reduce the patient’s exposure time. If possible, a gonad or ovarian shield should be used in order to further protect the patient.
There are other tests that can be performed to aid in diagnosing the disease. Bone scans will see if there are any degenerative changes to the joints. An MRI produces detailed images of organs and structures with in the body. Arthrograms can be