A 7-Year-Old Boy With Left Hip and Knee Pain

Derik L. Davis, MD; Ogechukwu R. Menkiti, MD; Brighita Weinberg, MD

Disclosures

August 31, 2016

Important priorities in the treatment of Legg-Calvé-Perthes disease include maintaining the spherical shape of the femoral head and containing its presence within the acetabulum. Alleviation of symptoms and restoration of range of motion of the lower extremity are desired clinical outcomes. Various therapeutic strategies are used for patient management, but there is still controversy over which methods of intervention are optimal for each patient and how best to grade the severity of disease. The general philosophy of the surgeon on these matters typically dictates the treatment plan. Management is directed by the patient's symptoms and the severity of the disease, as determined by imaging studies.

The bone age of the child is another important consideration for treatment.[4,6,7] Patients younger than 6 years or older children whose condition is classified in Catterall Group I may require only conservative management, without surgery. These children may receive range-of-motion exercises, traction, avoidance of weight bearing, and/or bracing as the only therapy. In certain children, only bedrest and anti-inflammatory medications may be indicated. In older children or in those with advanced disease (Catterall Groups III and IV), surgical intervention may be necessary. Various procedures are employed, depending on the clinical situation and surgeon's preference, to avoid long-term disability.

The patient in our case was placed on crutches and given instructions not to bear weight on the left lower extremity. Following discharge from the ED, he received follow-up evaluation by the pediatric orthopedics service of an affiliated institution, and he subsequently received surgical management 4 months later.

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