NCLEX Review Guide: Legg-Calvé-Perthes Disease

Disease Overview

• Legg-Calvé-Perthes disease is an avascular necrosis of the femoral head occurring in children ages 4-8 years, with boys affected 4-5 times more than girls.
• The condition involves temporary loss of blood supply to the femoral head, leading to bone death and eventual regeneration over 2-4 years.
• The disease progresses through four stages: initial/necrosis, fragmentation, reossification, and residual/healed.

Clinical Manifestations

• Insidious onset of painless limp that may worsen with activity and improve with rest.
• Hip pain that may radiate to the knee, thigh, or groin area, often described as aching or stiffness.
• Limited range of motion, particularly internal rotation and abduction of the affected hip.
• Trendelenburg gait pattern due to weakness of hip abductor muscles.

Diagnostic Procedures

• X-rays are the primary diagnostic tool, showing flattening, fragmentation, and sclerosis of the femoral head.
• MRI may be used in early stages to detect avascular changes before X-ray changes are visible.
• Bone scans can help assess blood flow to the femoral head and determine disease activity.

Treatment Approaches

• Containment therapy aims to keep the femoral head properly positioned in the acetabulum during healing.
• Conservative treatment includes activity restriction, physical therapy, and bracing (Petrie cast or abduction orthosis).
• Surgical intervention may include femoral osteotomy or pelvic osteotomy for severe cases or older children.

Nursing Interventions

1. Monitor for signs of complications including avascular necrosis progression or loss of containment.
2. Assess pain levels using age-appropriate pain scales and provide comfort measures as needed.
3. Encourage compliance with activity restrictions and assistive devices as prescribed.
4. Promote normal growth and development within physical limitations through adaptive activities.

Family Education

• Emphasize the importance of long-term follow-up as the condition takes 2-4 years to resolve completely.
• Teach proper use and care of braces or assistive devices, including skin assessment and hygiene.
• Encourage participation in non-weight-bearing activities like swimming to maintain fitness and social interaction.
• Discuss the need for activity modifications, avoiding high-impact sports during active disease phases.

NCLEX Success Strategies

• Remember that painless limp is the hallmark sign - don't confuse with painful conditions like SCFE.
• Focus on the containment principle - keeping the femoral head in proper position during healing.
• Understand that this is a self-limiting condition that requires patience and long-term management.