A New Skeletal Maturity Methodology for Children With Legg-Calve-Perthes Disease

Area of Science:

• Pediatric Orthopedics
• Skeletal Maturity Assessment
• Radiographic Analysis

Background:

• Legg-Calve-Perthes disease (LCPD) outcomes depend on age and maturity at onset.
• Children with LCPD often exhibit delayed skeletal maturity, up to 1.9 years younger than their chronological age.
• The standard Greulich and Pyle (GP) atlas for bone age assessment requires a separate hand radiograph.

Purpose of the Study:

• To develop and validate a novel method for assessing skeletal maturation in children with LCPD.
• To compare the accuracy of the new method against the established GP bone age assessment.
• To determine if the new method can predict GP bone age without additional hand imaging.

Main Methods:

• Retrospective review of a prospective, multicenter study of LCPD patients (1984-1991).
• Development of the GT+ Sex formula using greater trochanteric height, femoral head diameter, and patient sex.
• Comparison of GT+ Sex bone age and GP bone age with chronological age (CA) to calculate mean discrepancies.

Main Results:

• The GT+ Sex method showed a mean skeletal age discrepancy of 1.4 years younger than CA, similar to the GP method.
• GT+ Sex bone age assessment strongly correlated with GP bone age (R=0.89, P<0.0001).
• The GT+ Sex method exhibited fewer sex-based differences in skeletal age discrepancy compared to the GP method.

Conclusions:

• The GT+ Sex skeletal maturity assessment system is a valid alternative to the GP bone age system for LCPD patients.
• This novel method provides accurate skeletal age assessment without requiring hand radiographs.
• The GT+ Sex system offers a potentially simpler and more efficient approach to evaluating bone age in LCPD.