Key points to remember• • • Perthes disease is a disease of the hip joint every case of Perthes disease is different see your GP (general practitioner) immediately if your child limps for more than 48 hours most children with Perthes disease recover completely; 75 - 80 percent recover to have normal functioning hips • Back to Top What is it? Perthes disease is the name used for a condition which affects the ball-shaped end of the thigh bone (femoral head), where it enters into the formation of the hip joint. In this condition, the femoral head goes through a series of changes in which it softens, may become flattened and then gradually re-forms, (for more detail see What are the stages of the disease?). Back to Top What causes it? Perthes disease develops because the ball-shaped end of the thigh bone (femoral head) has its blood supply disturbed. It is not known why this happens. Back to Top What are the stages of the disease? The process of the illness can be divided into stages: 1. The blood supply to the ball-shaped end of the thigh bone (femoral head) becomes reduced. The reduced blood supply affects the bone cells in the femoral head, causing them to die (avascular necrosis). 2. The femoral head may change from a rounded to a flattened shape as the bone is weakened. It no longer fits properly into the hip socket. It removes the dead cells and replaces them with new bone cells (re-ossification). 4. Your child’s body tries to remodel the femoral head to a rounded shape. 3. Your child’s body starts to repair itself by forming new blood supplies (revascularisation) to the femoral head. Back to Top What are the symptoms? It is important to understand that every case of Perthes disease is different; no two children will have an identical course. Your child may have some of the following symptoms: • • • • • an occasional limp early in the illness pain in the knee, thigh, groin or hip when your child puts weight on the affected side limping and pain getting worse as time goes by reduced movement of the hip joint (stiffness) the leg on the affected side becoming thinner and sometimes shorter if your child has had the condition for a long time Back to Top What could this mean for my child? Most children who develop Perthes disease have been very active and are often very involved in sporting activities. To manage their symptoms it is usually necessary to take them out of competitive and impacting sporting activities for a period and this can have a major psychological effect on the child. It is important to explain that Perthes disease does heal and that the reason for restricting activities is so that your child will have a better functional hip for sports in the longer term. Giving your child timeframes is very important so that they realise that they will eventually be able to return to the activities they enjoy. Sometimes it is also necessary to explain this to your child's friends, teachers and coaches. Back to Top How long could it last? The condition develops slowly. The symptoms - limp, pain in the hip or knee - can also develop slowly; they will often come on after sport or activity. The disease may be present for some time before anyone notices the symptoms. There may be no pain initially. The recovery phase takes a long time - rarely less than 18 months; often two years or even longer. This may seem an unbearably long period of disability, but considered in relationship to your child’s total life span, it is not long. Most children with Perthes disease return to normal activities without major limitations. Back to Top What puts my child at risk of getting it? Perthes disease usually develops in children between the ages of about four to ten years when the stage of development of the femoral head makes it especially liable to an interruption in blood supply. Perthes disease occurs much more commonly in boys than in girls . Diagnosis at an early age is associated with a better hip recovery. Although the cause of Perthes disease remains unknown. If your child complains of an ache in their “good leg”. Back to Top .boys are four to five times more likely to develop it than girls. the x-ray may be normal. there are other problems which may be causing your child to limp. The opposite hip may become affected either at the same time or later. Delayed treatment or diagnosis after the age of eight may affect the outlook. other tests may be needed such as: • • a bone scan. Back to Top How is it diagnosed? Your child will need to have an x-ray. tell the doctor. In this case. Perthes disease cannot be diagnosed by a blood test. Back to Top When should I seek help? You should see your GP (general practitioner): • • immediately the condition is suspected. or an MRI (magnetic resonance imaging) scan Sometimes blood tests are needed to rule out infection and other causes of hip pain. In the early stages of the disease. Back to Top What about the other hip? Approximately 85 percent of children with the disease have only one affected hip joint. it has been observed to occur more commonly in smaller children. or if your child limps for more than 48 hours Besides Perthes disease. in approximately 15 percent of cases both of the hip joints are affected. What treatments are required? Your child will need to see an orthopaedic doctor (bone specialist) at the hospital to monitor the condition. (You must follow the dosage instructions on the bottle. Further treatments may include: • • • • • traction to the affected leg braces to hold the legs apart a plaster cast for protection and support and to keep the femoral head in the hip socket . surgery is only recommended in a minority of cases . It is dangerous to give more than the recommended dose). It is important to keep your child as comfortable as possible. such as paracetamol.this helps the femoral head to remodel itself to fit neatly into the socket physiotherapy. The physiotherapist will be able to help you with this. including swimming . Use pillows or cushions to help your child get into the most comfortable position.the orthopaedic doctor (bone specialist) can give you more information about this • Further x-rays and sometimes other tests will be needed to see if the condition is improving or getting worse. Often a period of bed rest with no physical activity is necessary to ease severe pain and limping. Many children with Perthes disease only require observation and x-ray from time to time. . Pain relief medication is often required. Back to Top How can I care for my child at home / at school? You will need to follow the instructions given to you by the doctors and nurses.this is important to help keep the muscles strong and increase movement of the hip joint use of a wheelchair to prevent weight-bearing surgery. The type of treatment depends on the following factors: • • • • • the age of your child the severity of the disease the x-ray and scan results the amount of hip pain how stiff the hip joint is The treatments are aimed at trying to keep the ball-shaped end of the thigh bone (femoral head) as smooth and round as possible. which may be used to protect the ball-shaped end of the thigh bone (femoral head) from becoming deformed. nlm. Sometimes the femoral head becomes swollen beyond its normal size and if this occurs.com/doc/11888420/Coxa-Plana-Pathophysiology Legg-Calve-Perthes Disease (Coxa plana) Author: Derek Moore MD Topic updated on 09/09/11 6:20pm Introduction Idiopathic avascular necrosis of the proximal femoral epiphysis ○ link with abnormal clotting factors (Protein Sand Protein C) is controversial • Epidemiology ○ 4-8 years most common age presentation • ○ ○ male to female ratio is 5:1 bilateral in 12% (never simultaneous) • Increased incidence with ○ positive family history . In these cases. involve your child in decisions about their care. the more severe the case.scribd. This may be a source of disability in the hip but this is rare. children recover completely from Perthes disease. As recovery from the illness can take a number of years. In general. the femoral head does not return to its normal shape.ncbi.Your child can and should go to school as normal. it may become squashed out of its normal smoothly rounded shape. Back to Top Are there likely to be any complications? In most cases.nih. the new bone grows into a deformed shape which remains for the rest of your child’s life. but some restriction of physical activities may be necessary. Check with your doctor which activity / games / sports are allowed and tell your child’s teacher. the greater the chance of your child having the following: • • • limited hip movement different leg lengths arthritis of the affected hip joint as an adult http://www.gov/pmc/articles/PMC1129426/?page=7 http://www. or thigh pain • Physical exam ○ hip stiffness with loss of internal rotation and abduction ○ Trendelenburg gait (head collapse leads to decreased tension of abductors) ○ limb length discrepancy is a late finding Imaging • Radiographs ○ early findings include joint space widening (earliest) irregularity of femoral head ossification . Reossification Healed or reossified Presentation • Symptoms ○ painless limp ○ knee.○ low birth weight ○ abnormal birth presentation ○ children exposed to second hand smoke • Prognosis correlates ○ bone age at onset onset at < 6 years has good prognosis > 6 years has a much worse prognosis ○ lateral pillar classification Pathophysiology Stages of Legg-Calves-Perthes (Waldenström) Initial Fragmentation Infarction occurs. hip. New bone appears. Result of a revascularization process and bone resorption. Lateral pillar classification based on this stage. Femoral head reossifies back to normal bone density. Radiographs may remain occult for 3 to 6 mos. Femoral head appears to fragment or disolve. uniformly good outcome .Differential diagnosis of Hip Pain in Children Treatment • Main goals of treatment is to keep femoral head contained and maintain good motion ○ good outcome correlates with spherical femoral head • < 6 years of age ○ leave alone • > 6 years of age (treatment is controversial) ○ nonoperative .fragmentation involves < 1/2 of femoral head ○ Stages III and IV .maintains < 50% height. cresent sign (represents a subchondral fracture) Classification • Herring lateral pillar classification ○ determined on AP xray at start of fragmentation stage.involves > 1/2 of femoral head Stulberg classification ○ gold standard for rating residual femoral head deformity and joint congruence recent studies show poor interobserver and intraobserver reliability Differential diagnosis • Table . poor outcomes in all patients ○ has best interobserver agreement • Catterall classification ○ Stages I and II . poor outcome in patients > 6 Group C .fragmentation involves > 1/2 of femoral head • Salter-Thompson classification ○ Class A .cresent sign involve less than 1/2 of femoral head ○ • Class B . which usually occurs 6 months after the onset of symptoms Group A Group B years .lateral pillar maintains full height.maintains 50 to 100% height. NSAIDS. phsyica therapy to regain motion casting or bracing to produce containment ○ operative femoral or pelvic osteotomy for late symptoms usually reserved for patients > 8 years large recent studies show improved outcomes with surgery for lateral pillar B and B/C not beneficial for lateral pillar A and C Complications • Residual head and neck deformity ○ coxa magna (widening) ○ ○ coxa breva (shortening) coxa valga (tilting of femoral neck) overgrowth of greater trochanter ○ flattening of femoral head ○ (A) Normal hip joint.activity restriction. (C) coxa valga . partial weight bearing with crutches. (B) coxa vara. Unsourced material may be challenged and removed. (B) coxa vara. (C) coxa valga Legg–Calvé–Perthes syndrome From Wikipedia. (August 2011) Legg–Calvé–Perthes syndrome Classification and external resources Upper extremity of right femur viewed from behind and above. the free encyclopedia This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. .(A) Normal hip joint. The disease is typically found in young children. It is also known more simply as Perthes disease.[1]ischemic necrosis of the hip.ICD-10 M91. osteochondritis and avascular necrosis of the femoral head. The effects of the disease can sometimes continue into adulthood. and it can lead to osteoarthritis in adults. The disease is characterized by idiopathic avascularosteonecrosis of the capital femoral epiphysis of the femoral head leading to an interruption of the blood supply of the head of the femur close to the hip joint.1 ICD-9 732. Contents [hide] • • • • • • • 1 Cause 2 Signs and symptoms 3 Diagnosis 4 Treatment 5 Incidence 6 Prognosis 7 Legg–Calvé–Perthes . It is named for Arthur Legg. coxa plana. where growth/loss of bone mass leads to some degree of collapse of the hip joint and to deformity of the ball of the femur and the surface of the hip socket. Jacques Calvé and Georg Perthes[1][2][3][4] and was first described by Karel Maydl[citation needed]. Legg–Perthes Disease or Legg–Calve-Perthes Disease (LCPD).1 OMIM 150600 DiseasesDB 9891 MedlinePlus 001264 eMedicine radio/387 MeSH D007873 Legg–Calvé–Perthes syndrome is a degenerative disease of the hip joint. short stature. over the years many theories have been published but none have stood up to professional research. a number of factors have been implicated including heredity. The child may then engage in activities appropriate for six years old child but lacking the bone strength of an older child. [5] Risk factors are not limited to impaired and disproportionate growth. some activity can cause severe irritation or inflammation of the damaged area including standing. kneeling. running. or stooping repeatedly for an extended period of time. or groin pain. possibly severe. systemic hormonal changes and low economic index [6] Although no-one has identified the cause of Perthes disease it is known that there is a reduction in blood flow to the joint. not allowing for time when the medial circumflex femoral artery takes over. and Perthes deduced an infection possibly causing degenerative arthritis leads to LCP disease. a child may be six years old chronologically but may have grown only four years old in terms of bone maturity. Genetics do not appear to be a determining factor. [edit]Signs and symptoms Common symptoms include hip. . and altered circulatory hemodynamics. [7][citation needed] For example. trauma. walking. mostly male children of Caucasian descent. The pain feels like a tooth ache. these activities may lead to flattening or fracture of the hip joint. LCP disease is a vascular restrictive condition of idiopathic nature. Calve ricketts. Children affected by LCP disease often display uneven gait. inflammatory. but these have not been proven. In some cases. Presently. knee. flattening and collapse occurs typically between ages four to ten. delayed skeletal maturity. limited range of motion and they experience mild to severe pain in groin area. exacerbated by hip/leg movement.disease in dogs • • 8 References 9 External links [edit]Cause Legg believed cause was impairment of blood supply to the femoral epiphysis. There may be atrophy of thigh muscles from disuse and an inequality of leg length. endocrine. but it has been suggested that a deficiency of blood factors with anticoagulant property used to disperse blood clots may lead to blockages in the vessels supplying the joint. low birth weight. The medial femoral circumflex artery is the principle source of blood supply to the femoral head. nutritional. Symptoms like femoral head disfigurement. There is a reduced range of motion at the hip joint and a painful or antalgic gait. if that were the case it is possible that their deficiency could cause clot formation in ligamentum teres femoris artery and hinder blood supply to the femoral head. It has also been suggested that there is a deficiency of proteins C and S which also act as blood anticoagulants. The disease is theorized to include the artery of ligmentum teres femoris being constricted or even blocked too early. However there is no evidence of this. not unlike a localizedcharley horse. (The differential diagnosis for Bi-lateral Perthes disease is Multiple Epiphyseal Dysplasia. using an external fixator which relieves the hip from carrying the body's weight. Neither bone scan nor MRI offer any additional useful information beyond that of x-rays in an established case. Perthes is generally diagnosed between 5 and 12 years of age.} [8] Onset of pain may be up to 4 hours after inactivity. Many children need no intervention at all and are simply asked to refrain from contact sports or games which impact the hip. For older children. and extend the length of the limbs to the floor. Younger children have a better prognosis than older children. Options include traction (to separate the femur from the pelvis and reduce wear) braces (often for several months. It is predominantly a disease of boys (4:1 ratio). particularly when tired. [edit]Diagnosis X-Rays of the hip may suggest and/or verify the diagnosis. Most functional bracing is achieved using a waist belt and thigh cuffs derived from the Scottish-Rite Orthosis. X-rays usually demonstrate a flattened. To maintain activities of daily living. and surgical intervention when necessary because of permanent joint damage. Orthoses can start as proximal as the lumbar spine (LSO). [9] These devices internally rotate the femoral head and abduct the leg(s) at 45 degrees. [edit]Treatment The goal of treatment is to avoid severe degenerative arthritis. due to the child favoring the injured side and placing the majority of their weight on the "good" leg. the distraction method has been found to be a successful treatment. Typically the disease is only seen in one hip. newsletters. If MRI or bone scans are necessary. pain is felt in the unaffected hip and leg[citation needed]. Over night traction may be used in lieu of walking devices or in combination. This allows room for the top of the femur to regrow.The first signs are complaints of soreness from the child. The pain is usually in the hip. In some cases. but bilateral Perthes is seen in about 10% of children diagnosed. with an average of 18 months) to restore range of motion. custom orthotics may be used. Orthopedic assessment is crucial. and events for the families to help children and parents to feel less isolated. . which are often dismissed as growing pains. This lasts for an hour or so and returns nightly on inactivity. a positive diagnosis relies upon patchy areas of vascularity to the capital femoral epiphysis (the developing femoral head). and later fragmented. femoral head. a helpline. and limping or other guarding of the joint. Abone scan or MRI may be useful in making the diagnosis in those cases where xrays are inconclusive. but can also be felt in the knee ('referred pain').[10] These devices are typically prescribed by a physician and implemented by a certified orthotist. Knee pain is felt in the back of the knee rather than in the front. physiotherapy. Treatment has traditionally centered on removing pressure from the joint until the disease has run its course. although it has been diagnosed as early 18 months. The Perthes Association has a "library" of equipment which can be borrowed to assist with keeping life as normal as possible. [14] Children who have been diagnosed with Perthes' Disease after the age of 10 are at a very high risk of developing osteoarthritis and Coxa Magna.5 of 100. Maternal tobacco smoking appears to be another significant risk which carries a risk five times higher than those not exposed to smoking. Pressure is minimized on the hip through use of crutches or a cane. Most cases of Perthes disease have presented themselves by age 14 years old. It is recommended not to use steroids or alcohol as these reduce oxygen in the blood which is needed in the joint. Male to female ratio of occurrence is 5:1. [12] Caucasians are affected more frequently than other races. but generally is required any time after age 50. [edit]Incidence Perthes is rare. Cycling is another good option as it also keeps stress to a minimum. Physiotherapy generally involves a series of daily exercises.[11] Perthes disease is self limiting. 1 in 100 male children of adults with Legg–Calvé–Perthes syndrome also exhibit the syndrome. As sufferers age. Hip replacements are relatively common as the already damaged hip suffers routine wear. These exercises focus on improving and maintaining a full range of motion of the femur within the hip socket. Performing these exercises during the healing process is essential to ensure that the femur and hip socket have a perfectly smooth interface. Swimming is highly recommended. [13] [edit]Prognosis Children younger than 6 have the best prognosis since they have time for the dead bone to revascularize and remodel. Use of zoledronic acid has also been investigated. It is most commonly seen in persons aged 3–12 years. and the avoidance of running-based sports. Treatment is aimed at minimizing damage while the disease runs its course.[citation needed] In the US. not at 'curing' the disease. with weekly meetings with a physiotherapist to monitor progress. This will minimize the long term effects of the disease. a better . Second hand and side stream smoke appear less significant than maternal ingestion during pregnancy. with a good chance that the femoral head will recover and remain spherical after resolution of the disease. When an LCP disease diagnosis occurs after age eight. as it allows exercise of the hip muscles with full range of motion while reducing the stress to a minimum. but if the head of femur is left deformed there can be a long-term problem. occurring in approximately 5. though this appears not to be an inevitable consequence. problems in the knee and back can arise secondary to abnormal posture and stride adopted to protect the affected joint. The condition is also linked to arthritis of the hip.Modern treatment focuses on removing pressure from the joint to increase blood flow.000 children per year (and therefore a lifetime risk of developing the disease is about 1 per 1200 individuals). in concert with physiotherapy. 1 in 1200 children younger than 15 years will have this condition. with a median of 6 years of age. Maternal cigarette smoking adds confounding factors beyond biological and environmental. this varies by individual.[citation needed] Children of sufferers of the disease themselves have a very slightly increased risk. while the occurrence in the UK is a slightly more common. • RaceCaucasians are affected more frequently than persons of other races. I n c i d e n c e s • United StatesOne in 1200 children younger than 15 years is affected by LCPD. with amedian age of 7 years.[22] The prognosis is excellent with surgery. but conservative treatment (rest. As in children. There seems to be no sex predilection in the dog as contrasted to humans. D e f i n i t i o n Legg-Calve-Perthes disease is when the head of the thighbone (femur) inthe hip deteriorates due to insufficient blood supply to the area. I I . Jack Russell Terriers. with a peak incidence at about 7 months. [21] The disease is bilateral in 12 to 16 percent of cases. • AgeLCPD most commonly is seen in persons aged 3-12 years. and later in the disease. Perthes disease I I I . however. and pain medication) may be effective in a limited number of cases (less than 25 percent. as did Waldenstromin 1(1909) in humans. exercise restriction. [20] Hip pain is usually seen by the age of 6 to 8 months.Risk/ Predisposing Factors • . [19] The pathology of avascular necrosis followed by revascularization and bony remodeling of the femoral head in the dog certainly suggests a vascular etiology even though the cause of the condition is not completely understood. LCP disease is an osteonecrosis of the femoral head in small breed dogs. collapse and fracture of the neck of the femur.[18] Toy and small breeds. hence. [edit]References Coxa PlanaI . The age of onset varies between 4 months and 12 months. and Dachshunds can be affected. small breed dogs (LCP disease) was first described in veterinary literature by Tutt in 1935 [17]: he described the disease. with only about 10% to 15% incidence of bilateral disease. • SexMales are affected 4-5 times more often than females. the shape of femoral head and congruence of hip are most useful outcome measures. the condition is usually unilateral. usually those weighing less than 12 kg. Pugs. particularly Toy Poodles.[16] [edit]Legg–Calvé–Perthes disease in dogs Osteonecrosis of the femoral head of young. The recommended treatment is surgical removal of the head of the femur. [15] Shape of femoral head at the time when Legg-Calve Perthes Disease heals is the most important determinant of risk for degenerative arthritis.[22] X-rays are necessary to make the diagnosis and show increased opacity and focal lysis in the head of the femur. IV. Yorkshire Terriers.outcome results with surgery rather than non-operative treatments. in whom an 80% male incidence of the disease is evident. according to some studies). A K A ( a l s o k n o w n a s ) Legg-Calve-Perthes disease. infection and metabolic abnormalities. particularly with internal rotation andabduction • Painful gait • Muscle spasm • Leg length inequality due to collapse • Thigh atrophy: Thigh circumference on the involved side will be smaller than on the unaffected side secondary to disuse. initially) • Persistent thigh or groin pain • Atrophy (wasting) of muscles in the upper thigh • Slight shortening of the leg. or legs of unequal length • Hip stiffness restricting movement in the hip • Difficulty walking. and boner e s o r p t i o n a n d d e p o s i t i o n t a k e p l a c e ( l a s t s e v e r a l m o n t h s t o 1 y e a r ) Ho wever the new bone lacks strength and pathologic fractures may occur. trauma. • R i s k g r o u p a l s o i n c l u d e s t h o s e w h o h a v e a b n o r m a l i t i e s i n g e n e t i c s .Legg-Calve-Perthes disease occurs most frequently in boys 4 to 10 yearsold. hormonal changes. w h i c h g r a d u a l l y s p r e a d s t o h e a l t h e l e s i o n ( l a s t s 2 t o years) .Type/Stage/Classifications of the Disease • Stage I (avascularity)T h e b l o o d s u p p l y t o t h e u p p e r f e m o r a l e p i p h y s i s i s h a l t e d spontaneously and bone growth is halted (lasts a few weeks) • Stage II (revascularization)New blood vessels arise to supply the necrotic area. walking with a limp (which is often painless) • Limited range of motion • Decreased range of motion (ROM). VI. • Short stature: Children with LCPD often have delayed bone age.the weakened epiphysis may be progressively deformed • Stage III (reossification)The head of the femur gradually reforms as dead bone is replacedw i t h n e w b o n e . Recent research shows that this disorder may reflect subtle disordersof blood clotting. M a n i f e s t a t i o n s • Knee pain (may be the only symptom. N u r s i n g D i a g n o s i s • Top 5 Priorities includes:1 . such as swimming and bicycling. w a l k e r ) i f needed4.Allow child to care for self and participate as able.2 . 8.Nursing Responsibilities Preoperative Management1. and pain in the joint and help restore motion.V. • Surgical1 . P r o v i d e e q u i p m e n t t o a s s i s t w i t h m o b i l i t y ( e . vitamins and nutritionalsupplements as indicated.Salicylates or anti-inflammatory agents are given to relieve synovitis. with resultant joint misalignment 1.2.Ineffective Therapeutic Regimen Management XI.6 .5.7 .Limitation of activities. D e t e r m i n e i f t h e p a t i e n t h a s h a d p r e v i o u s c o r t i c o s t e r o i d t h e r a p y – c o u l d contribute to current orthopedic condition (aseptic necrosis of the femoral head. I m p a i r e d P h y s i c a l M o b i l i t y 4 . D i s t u r b e d B o d y I m a g e 5. acetabulum (Salter innominate). protein and caloric intake. fluids. S t r e s s positive aspects of activity.Bathing or Self-Care Deficit3 . o s t e o t o m y o f t h e p r o x i m a l f emur. but to avoid contact sportsand high impact-running. Maximize healingand reduce risk of complications by providing I.muscle spasm.• Stage IV (postrecovery)The femoral head becomes permanently distorted. or a combination of these maybe required X . v a r u s o s t e o t o m y . R e i n f o r c e t o c h i l d t h a t h e o r s h e i s o n l y t e m p o r a r i l y r e s t r i t e d . .Instruct child and parents to maintain activities that promote range of motion. g w h e e l c h a i r . E n c o u r a g e f o l l o w u p . hydration.Teach parents and siblings to assist only as needed. bed rest with or without skin traction3 . A c u t e P a i n 2. I n o m i n a t e o s t e o t o m y .Assess nutritional status. . Report increased wound drainage or steady increase in pain of operativearea.c. asindicated by the type of surgery. .osteoporosis). H a v e the patient practice voiding on bed pan or urinal in r e c u m b e n t p o s i t i o n before surgery. d e n t a l .4 . U T I ) . frequent v/s and wound checks and repositioning. i t c o u l d contribute to development of osteomyelitis after surgery.Watch for increased oozing of wounds.Watch circulation distal to the part where cast.5 .a. color.6. P r e p a r e p a t i e n t f o r p o s t o p e r a t i v e r o u t i n e s .b. as well as affect his or her response to anesthesia and the stressof surgery. and capillary refill.b.V fluids or blood products as ordered. s k i n . E v a l u a t e t h e b l o o d p r e s s u r e a n d p u l s e r a t e s f r e q u e n t l y – r e p o r t r i s i n g pulse rate or slowly decreasing blood pressure.Measure suction drainage if used. D e t e r m i n e i f t h e p a t i e n t h a s a n i n f e c t i o n ( c o l d .Monitor for hemorrhage and shock.Prevent constriction leading to interference with blood or nerve supply.Monitor neurovascular status. warmth.2.Note movement.3 .a . This helps reduce the need for post operative catheterization. w / c i n c l u d e c o u g h i n g a n d d e e p breathing. Anticipate up to 7 to 17 oz (200 – 500mL) drainage in the first 2 hours. The patient may need corticotrophin postoperatively. Administer preoperativeantibiotics as ordered. depending on surgical procedure. decreasing to less than 1 oz (30 mL) per 8 hours within 48 hours.Acquaint the patient with traction apparatus and the need for splint or cast. or splint has beenapplied.Post operative Management1.c.check for swelling. which may result from significant bleedingand poor hemostasis of muscles that occur with orthopedic surgery. and ask about sensation of distal extremities.d.3. check pulses. bandage.Administer I. . to prevent thromboembolism.8.14.4.s e t t i n g exercises (quadriceps setting) if active motion is contraindicated.15.Maintain aseptic technique for dressing changes and wound care. and encourage other fluids to prevent other fluids to prevent urinary calculi .Apply antiembolism stockings.7 .Encourage early resumption of activity.com/doc/17647415/Coxa-Plana .Immobilize the affected area and limit activity to protect the operative site andstabilize musculoskeletal structures. especially after fracture of long bones. http://www.12.11. notify health care provider if not effective or if the patient cannot tolerate adverse effects. G i v e a n a l g e s i c s t h a t m a y c a u s e r e s p i r a t o r y d e p r e s s i o n c a u t i o u s l y.10.Encourage the patient to move joints that are not fixed by traction or appliancet h r o u g h t h e i r r a n g e o f m o t i o n a s f u l l y a s p o s s i b l e . or give prop hylacticanticoagulants. M o n i t o r v / s f o r f e v e r . Monitor r e s p i r a t i o n d e p t h a n d r a t e f r e q u e n t l y .Monitor for anemia. M o n i t o r p a i n l e v e l a n d r e s p o n s e t o a n a l g e s i a . sequential compression. a d m i n i s t e r p a t i e n t c o n t r o l l e d analgesia or other method of pain relief as directed.5 .scribd.Elevate affected extremity and apply ice packs as directed to reduce swelling andbleeding into tissues.6. o r i n c r e a s e d r e s p i r a t o r y r a t e . Auscultate lungs frequently. w h i c h m a y indicate infection. O p i o i d a n a l g e s i c e f f e c t s m a y b e cumulative.13. if prescribed.Change position and encourage use of incentive spirometer and coughing anddeepbreathing exercises every 2 hours to mobilize secretions and preventatelectasis.Avoid giving calcium supplements patients on bed rest. t a c h y c a r d i a .9 . S u g g e s t m u s c l e .