Pelvis Case #3

H&P7 yo boy presents to

the er complaining of several weeks of left hips and knee pain. Mom brings him in today because she notes that he has been limping. They deny history of trauma. No fevers, weight changes, or other complaints.

PEAfebrile. VSSGen: Well

appearing, non-toxic. Short stature.

Extrem: Decrease ROM left hip. Esp w/ internal rotation and abduction

Legg-Calve-Perthes Disease

Consider differential diagnosis – Sickle cell disease, septic hip, trauma

Consider CBC and ESR. B/L hip films and frog leg views can be helpful

NSAIDs are the mainstay for treatment of pain control

Orthopedic follow-up

ED Management

Caused by interruption of blood flow to the capital femoral epiphysis. Bone infarction occurs and subchondral fractures occur

Most common in males. Patients that present at a younger age

typically have a better outcome15-20% of patients have bilateral problems

but they are typically at different stages

Pearls

Other images

Nochimson, G et al. “Legg-Calve-Perthes Disease in Emergency Medicine”. Emedicine.com. 4/2011.

Tininalli, J et al. “Emergency Medicine: A Comprehensive Study Guide”. 6th ed. 2003

Wheeless, C. “Legg-Calve-Perthes Disease”. Wheelessonline.com. 4/2011.

References