Review Question - QID 105604

This patient is presenting with hip pain, decreased range of motion, and a radiograph demonstrating Legg-Calve-Perthes disease (idiopathic avascular necrosis of the femoral capital epiphysis).

Legg-Calve-Perthes disease presents with unilateral subacute hip pain in a male child (often 4-10 years of age). The child presents with an antalgic gait, decreased hip range of motion, and may have thigh muscle atrophy. Radiography will reveal collapse of the ipsilateral femoral head. A technectium bone scan may also be performed, which would show decreased uptake at the epiphysis (due to decreased blood flow). Since this is not an inflammatory condition, the ESR/CRP are often normal. The goal of treatment is to contain and protect the femoral head and hip joint from further injury while allowing healing to take place. It may include observation, bed rest, reduced weight bearing, bracing, or surgical osteotomy.

Figure A shows collapse of the femoral head, femoral head sclerosis, and an increased width of the femoral neck.

Incorrect Answers:
Answer 1: Congenital talipes equinovarus is the medical term for clubfoot which presents with the foot excessively plantar flexed with the forefoot swung medially and the sole facing inward.

Answer 3: Septic arthritis presents with an acute presentation including fever and a red, hot, inflamed, and tender joint. The ESR/CRP is often elevated and the diagnosis is confirmed with arthrocentesis.

Answer 4: Slipped capital femoral epiphysis presents as thigh/hip pain or referred knee pain in an obese adolescent boy. Radiography shows a classic "ice cream falling off a cone" femoral head displacement.

Answer 5: Trochanteric bursitis is inflammation of the trochanteric bursa (a bursa of the hip). It would not be associated with muscle atrophy. Trochanteric bursitis would present with pain over the trochanteric bursa with pain with ambulation.

Bullet Summary:
Legg-Calve-Perthes disease presents with hip pain, decreased range of motion, and radiography demonstrating collapse of the femoral head with sclerosis.