# A 7-year-old child is brought to the clinic by parents who report the child has been limping and complaining of hip pain for the past 2 weeks. Which assessment finding would be most characteristic of Legg-Calvé-Perthes disease?

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> subject: Child Health

## 문제

A 7-year-old child is brought to the clinic by parents who report the child has been limping and complaining of hip pain for the past 2 weeks. Which assessment finding would be most characteristic of Legg-Calvé-Perthes disease?

## 보기

1. Severe acute pain with inability to bear weight
2. Hip deformity with external rotation and shortening
3. Painless limp with limited hip abduction and internal rotation **✔ 정답**
4. Swelling and warmth over the affected hip joint

**정답: 3**

## 해설

Legg-Calvé-Perthes disease typically presents with a painless or mild pain limp, along with limited hip abduction and internal rotation due to avascular necrosis of the femoral head. Other options describe findings more characteristic of acute conditions like trauma or infection.

## 심화 해설

Clinical Presentation of Legg-Calvé-Perthes Disease

The most characteristic assessment finding for Legg-Calvé-Perthes disease (LCPD) in a school-aged child is a painless limp with limited hip abduction and internal rotation. LCPD is an idiopathic avascular necrosis of the capital femoral epiphysis that typically presents with an insidious onset, often leading to a delay in diagnosis . The classic clinical picture involves a child, most commonly between the ages of 5 and 7 years, who develops a limp that may be intermittent and is frequently described as painless, although mild activity-related pain in the hip, thigh, or knee can be present . The pathophysiologic process begins with an interruption of the blood supply to the capital femoral epiphysis, initiating a sequence of ischemia, revascularization, and reossification . During the revascularization phase, the subchondral bone becomes mechanically weakened, which can lead to a subchondral fracture and subsequent femoral head deformity . This structural compromise and the associated synovitis directly restrict the joint's range of motion, manifesting as a characteristic limitation in hip abduction and internal rotation. The limp arises from both the mechanical restriction and subtle leg-length discrepancy that can develop.

The other options describe findings that are less characteristic of the typical insidious presentation of LCPD. Severe acute pain with an inability to bear weight is more indicative of an acute fracture, septic arthritis, or transient synovitis with severe spasm. A hip deformity with external rotation and shortening is a late finding that may develop if significant femoral head deformity and collapse occur, but it is not the most characteristic initial presentation. Swelling and warmth over the hip joint are cardinal signs of an acute inflammatory or infectious process, such as septic arthritis, rather than the avascular, non-infectious pathology of LCPD.

## 임상 시나리오

Recognizing Legg-Calvé-Perthes Disease (LCPD)Key Clinical Indicators in a School-Aged Child
The hallmark presentation is an insidious onset, painless limp in a child, most commonly between 5 and 7 years old. The limp may be intermittent and is often the only initial complaint.

On physical exam, the most characteristic finding is restricted range of motion, specifically limited hip abduction and internal rotation. This is due to synovitis and subchondral fracture compromising the joint mechanics.

Pain, when present, is typically mild and activity-related. It may be referred to the thigh or knee, making the hip the hidden source. A Trendelenburg gait may be observed due to weakened hip abductors.

CautionDo not mistake referred knee pain for a primary knee problem. Always examine the hip in a limping child. Severe acute pain or signs of inflammation (swelling, warmth) should raise suspicion for septic arthritis, a medical emergency.

## 핵심 개념

- **Legg-Calvé-Perthes Disease (LCPD)** — Idiopathic avascular necrosis of the capital femoral epiphysis in children, typically ages 4-8, leading to femoral head deformity.
- **Capital Femoral Epiphysis** — The growth plate and head of the femur; its blood supply is interrupted in LCPD, causing bone death.
- **Synovitis** — Inflammation of the synovial membrane lining the hip joint, contributing to pain and restricted range of motion in LCPD.
- **Trendelenburg Gait** — An abnormal gait caused by weakness of the hip abductor muscles, often seen with a painful or mechanically compromised hip like in LCPD.
- **Subchondral Fracture** — A fracture in the bone just beneath the cartilage, a key early radiographic sign and structural weakening event in LCPD.

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