Legg-Calve-Perthes Disease in Emergency Medicine Treatment & Management

Updated: Mar 03, 2018
  • Author: Jessica Hernandez, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Treatment

Emergency Department Care

Goals of treatment of Legg-Calvé-Perthes disease include the following:

  • Containment of the femoral epiphysis within the confines of the acetabulum

  • Maintenance or improvement in range of motion

  • Relief of weight bearing

  • Provision of traction

  • Prevention of deformity and growth disturbances

  • Prevention of degenerative arthritis [10]

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Consultations

Once the diagnosis of Legg-Calvé-Perthes disease is suspected, an orthopedic surgeon or a pediatric orthopedic surgeon should be contacted for further management decisions.

An orthopedic consultant may choose to order more specialized tests (eg, bone scintigraphy, arthrography, MRI), usually in an outpatient setting, to better determine the extent of the disease.

Management is based on the age of onset and is divided into patients younger than 6 years, patients aged 6-8 years, and patients older than 8 years. [9]

Ultimately, patients can be managed either conservatively or operatively. This is decided on a case-by-case basis by the orthopedic specialist.

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Medical Care

Legg-Calvé-Perthes disease does not require emergent inpatient care. Initially, close follow-up is required to determine the extent of necrosis.Treatment may involve observation, usually in children younger than 6 years. Bed rest and abduction stretching exercises are recommended. Nonsurgical containment allows the femoral head to stay within the acetabulum, where it can be molded. Various casts, braces, and crutches have been used for containment.

Once the healing phase has been entered, follow-up can be every 6 months. Long-term follow-up is necessary to determine the final outcome.

Surgical treatment may benefit older patients; however, the ability of surgical treatment to achieve a normal hip at maturity is modest. [9, 24] Surgical correction of gross deformities of the femoral head may be necessary. Some studies have demonstrated that patients aged 6 years or older treated conservatively fared worse than those treated with surgery. [6]  In contradistinction, other studies show that surgical management in younger children does not improve long-term outcome. [2, 20, 25]

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