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Condition/Disorder Synonyms

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  • Juvenile osteochondrosis of hip and pelvis

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ICD-9-CM Code

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  • 732.1 Juvenile osteochondrosis of hip and pelvis

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ICD-10-CM Code

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  • M91.1 Juvenile osteochondrosis of head of femur

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Preferred Practice Pattern

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Key Features

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Description

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  • Impairment of blood flow to the hip resulting in destructive changes

  • Self-limiting disease of the hip

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Essentials of Diagnosis

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  • Age of onset or detection is best predictor of successful recovery

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General Considerations

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  • Four stages

    • 1. Condensation: bone stops and femoral head becomes necrotic

    • 2. Fragmentation of necrotic bone; femoral head and acetabulum become deformed; revascularization begins

    • 3. Reossification of femoral head

    • 4. Remodeling of femoral head and acetabulum

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Demographics

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  • Children aged 3 to 13 years old, especially males aged 5 to 7 years old

  • Males 3 to 5 times more likely than females

  • Usually unilateral; bilateral 10-20% of the time

  • Uncommon in African Americans

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Clinical Findings

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Signs and Symptoms

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  • Pain

  • Antalgic gait

  • Trendelenburg gait

  • Referred pain to groin, thigh, knee

  • May have limited hip internal rotation, abduction, extension

  • Muscle spasm of hip flexors and adductors

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Functional Implications

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  • Difficulty with ambulation, stairs

  • Limited hip mobility

  • Antalgic gait

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Possible Contributing Causes

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  • Avascular necrosis of hip (i.e., lack of blood flow to the capital femoral epiphysis) due to

    • Injury

    • Infection

    • Vascular anomalies (congenital or acquired)

    • Thrombus

    • Synovitis

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Differential Diagnosis

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Means of Confirmation

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Imaging

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  • X-ray of hip to evaluate for avascular necrosis

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Referrals/Admittance

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  • To orthopedic surgeon for

    • Anti-inflammatory medication

    • Traction

    • Orthotic prescription

      • Petrie cast2

      • Scottish-Rite brace3

      • Surgical repair including osteotomy

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Impairments

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  • Referred pain from hip

  • Muscle spasms of hip flexors and adductors

  • Gait deviations

  • Decreased mobility due to pain and partial weight-bearing with crutches

  • Decreased hip internal rotation, abduction, extension ROM

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Intervention

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  • For when patient released by physician for physical therapy after casting or surgical repair

  • Modalities to decrease pain

  • AROM and PROM of hip

  • Strengthening of hip

    • Hip abduction in standing or sidelying

    • Hip extension in standing or prone

      • Bridges

    • Sit-to-stand exercises

    • Wall squats

  • Gait training

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Functional Goals

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  • The patient will be able to

    • Increase hip AROM and PROM for internal rotation, abduction, extension

    • Increase strength of hip musculature, especially ...

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