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A New Skeletal Maturity Methodology for Children With Legg-Calve-Perthes Disease
William Woodhams1, K Aaron Shaw1, Michael O'Sullivan2
1Department of Orthopaedic Surgery, Children's Mercy Kansas City, Kansas City, MO.
Insights
A new GT+ Sex method accurately assesses skeletal maturity in Legg-Calve-Perthes disease (LCPD) patients, correlating with the Greulich and Pyle (GP) atlas. This approach avoids hand X-rays, simplifying bone age assessment for LCPD.
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.
Background:
Legg-Calve-Perthes disease (LCPD) outcomes are largely determined by their age and maturity at onset. In LCPD, there is a known association with delayed skeletal maturity of up to 1.9 years in affected children based on maturity assessment with the Greulich and Pyle (GP) maturity atlas. The GP atlas is the standard for assessing bone age but requires obtaining a separate radiograph of the hand. A new methodology for assessing skeletal maturation in comparison to the GP bone age in children with LCPD was sought.
Methods:
A retrospective review of a prospective, multicenter study of patients with LCPD treated from 1984 to 1991 and followed to skeletal maturity was performed. Patients were included if they had LCPD diagnosed on anteroposterior pelvis radiographs that included the contralateral hip who had bone age radiographs obtained at the time of presentation. Patients were excluded if they presented with bilateral LCPD, the contralateral hip was not visualized on their presenting radiographs, they lacked bone age radiographs at the time of presentation, or they presented outside the range for the Optimized Oxford system. A formula using the greater trochanteric height to femoral head diameter ratio and patient sex (GT+ Sex) for predicting GP bone age was developed. The GP and GT+ Sex bone ages were compared with the chronologic age (CA) to determine the mean discrepancy.
Results:
Seventy-one patients were included (mean 9.5 ± 1.2 y at presentation, 42.2% females). Skeletal maturity assessment by the GP bone age method demonstrated a mean discrepancy of 1.4 years younger than CA (95% CI: 1.01-1.76 y). GT+ Sex bone age assessment demonstrated a mean discrepancy of 1.4 years younger than CA (95% CI: 1.03-1.75 y). The GP bone age was a mean of 0.00 years different than the GT+ Sex assessment bone age (95% CI: -0.3 to 0.3 y). The GT+ Sex assessment bone age correlated significantly with GP bone age ( R =0.89, P <0.0001). Male patients had a significantly younger GP bone age relative to CA compared with female patients (1.8 vs. 0.86 y, P = 0.02); however, there were fewer sex differences in the GT+ Sex assessment bone age relative to CA (male, 1.77 y younger vs. 1.12 y younger; P = 0.01).
Conclusions:
The GT+ Sex skeletal maturity assessment system in children with LCPD significantly correlated with the GP bone age system when compared. The GT+ Sex assessment may provide an assessment of the true bone age in LCPD patients without the need for hand radiographic imaging studies.
Level Of Evidence:
Level III-retrospective review and analysis.
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