Pediatric emergency medicine trisk 3971 3971
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FIGURE 121.15 Legg–Calvé–Perthes disease of left hip. Epiphysis is narrowed and
radiodense. A subchondral fracture is also visible.
Initial Assessment/H&P
The onset of symptoms in LCPD is usually insidious. Presentation as an acute
emergency is rare. Mild hip pain and limp have usually been present for weeks to
months before diagnosis. Pain is often referred in the distribution of the obturator
nerve, including the knee, anteromedial thigh, or groin. Physical findings include
decreased hip abduction and internal rotation. Thigh muscle atrophy, and in
advanced cases, limb shortening may also be noted.
Management/Diagnostic Testing
The sequence of radiographic changes in LCPD has been described in detail (
Fig. 121.15 ). Gadolinium subtraction MRI may offer radiographic evidence of
disease during the first 3 to 6 months of symptoms when plain radiographs are
normal. At diagnosis, most patients have widening of the articular cartilage with a
small, dense proximal femoral epiphysis. Subchondral fracture may be visible.
Irregularity and flattening of the epiphysis develops over time. The differential
diagnosis includes various bone tumors and skeletal dysplasias. As the disease
progresses, anterolateral subluxation may be quantitated radiographically.
Management of LCPD requires a pediatric orthopedist who will follow and
treat the child through the various stages of the disease. Prompt referral may
influence long-term prognosis. Older children, obese children, girls, and those
