Presenting Complaints:

A 7-year-old male patient was brought to the pediatric orthopedic clinic by his parents with complaints of left hip pain and limping for the past several weeks. The parents noted that their child had been complaining of discomfort while walking and had an observable limp in his gait.

History of Presenting Complaints:

The parents reported that their son had started complaining of intermittent left hip pain and difficulty walking about 3 months ago. Initially, they attributed it to minor injuries from playing and thought it would resolve on its own. However, the pain persisted and progressively worsened, leading to the limping gait. The pain was described as dull and aching, primarily localized to the left hip joint.

Chief Complaints:

The chief complaints included left hip pain, limping, and difficulty in bearing weight on the left leg.

Past Medical and Surgical History:

The patient had no significant past medical or surgical history.

Family History:

There was no family history of Perthes disease or any other musculoskeletal disorders.

Socioeconomic Status:

The family is of middle socioeconomic status with access to basic healthcare facilities.

Present and Pre-morbid Functional Status:

Before the onset of symptoms, the child had a normal functional status, actively participating in school and extracurricular activities. However, since the onset of symptoms, his functional status had declined due to the difficulty in walking and participating in physical activities.

General Health Status:

Apart from the hip pain, the child had no other significant health issues, and his overall general health was good.

Vitals:

The patient’s vital signs were within the normal range for his age.

Aggravating Factors:

The pain was aggravated by physical activity, especially walking and running.

Easing Factors:

Rest and avoiding weight-bearing activities helped alleviate the pain to some extent.

Examination:

On physical examination, there was a noticeable antalgic gait, with the left leg being externally rotated and held in slight abduction. The range of motion of the left hip was limited, with pain on abduction and internal rotation. The left leg appeared to be shorter than the right, and there was a decreased muscle bulk in the left thigh. No signs of infection or skin changes were observed.

Sleep and 24-Hour Pattern:

The pain did not significantly affect the child’s sleep pattern, although he occasionally woke up in discomfort.

Duration of Current Symptoms:

The symptoms had been present for approximately 3 months.

Mechanism of Injury/Current Symptoms:

There was no specific mechanism of injury reported. The symptoms seemed to have developed gradually over time.

Progression Since the Current Episode:

The symptoms had progressively worsened over the past few months, leading to an increased limp and decreased mobility.

Significant Prior History:

No significant prior history was reported.

Previous Treatment:

The child had not received any prior treatment for the hip pain.

Diagnostic Test/Imaging:

X-rays of the left hip were taken, revealing changes consistent with Perthes disease, including femoral head deformity and joint space narrowing.

Differential Diagnosis:

Differential diagnoses considered included hip joint infection, transient synovitis, and Legg-Calvé-Perthes disease. However, imaging findings were suggestive of Perthes disease.

Postural Observation:

The postural observation revealed an antalgic gait, external rotation, and abduction of the left hip.

Precaution and Contraindications:

Weight-bearing on the affected leg was discouraged to prevent further damage to the femoral head. High-impact activities were also contraindicated.

Functional Movement Analysis (Sign):

The child exhibited limited range of motion and discomfort while attempting hip abduction and internal rotation.

Quick Screening Tests/Clearing of Additional Joint Structures:

Additional joint structures were cleared, and no significant abnormalities were found apart from the hip joint.

Range of Motion (ROM):

Limited hip abduction, internal rotation, and flexion were noted on ROM assessment.

Special Tests:

Additional special tests such as the Trendelenburg test and Patrick’s test were performed to assess hip joint stability and further confirm the diagnosis.

Assessment:

Based on the clinical presentation, X-ray findings, and special tests, the patient was diagnosed with Legg-Calvé-Perthes disease, a condition characterized by avascular necrosis of the femoral head in children.

Problem List/Complaints:

Left hip pain and limping.

Decreased range of motion in the left hip.

Femoral head deformity on X-ray.

Treatment:

The treatment plan included:

Conservative Management: Initially, the child was advised to rest and avoid weight-bearing activities on the affected leg. Physical therapy was initiated to maintain hip mobility and muscle strength.

Orthopedic Consultation: Regular follow-ups with a pediatric orthopedic specialist for ongoing assessment and management.

Bracing: In some cases, a brace or cast may be recommended to help maintain proper hip positioning and minimize deformity.

Surgery (if necessary): Surgical interventions, such as femoral or pelvic osteotomies, may be considered in advanced cases or if conservative treatment is ineffective.

Prognosis:

The prognosis for Perthes disease depends on the age of onset, the extent of femoral head involvement, and the response to treatment. With appropriate management, many children can expect to have good long-term outcomes and return to normal activities as they grow.

Goals:

The goals of treatment were to relieve pain, maintain hip function, and prevent further deformity of the femoral head.

Interventions:

The interventions included physical therapy, pain management, and regular orthopedic follow-ups. Surgical intervention would be considered if conservative measures proved insufficient.

Patient Education:

The parents and the child were educated about the nature of Perthes disease, the importance of compliance with treatment, and the need for ongoing monitoring by a healthcare provider.

Patient/Family Education:

The family was educated on how to assist the child in activities of daily living, the importance of adherence to weight-bearing restrictions, and potential complications if left untreated.

Discharge Plan:

The child was discharged with instructions to continue physical therapy and follow-up appointments with the pediatric orthopedic specialist. The family was provided with contact information for any questions or concerns. A multidisciplinary approach involving physical therapists, orthopedic specialists, and the family was essential for the successful management of Perthes disease.