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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