N.D. Siddesh

Quantitative Measures for Evaluating the Radiographic Outcome of Legg-calvé-perthes Disease

BACKGROUND Large sample sizes are needed if discrete outcome measures are used to perform outcome studies, whereas more practicable sample sizes are sufficient if continuous outcome measures are used. Recognizing the need to devise reliable continuous outcome measures for assessing the outcomes of treatment of Legg-Calvé-Perthes disease, we evaluated a method of quantifying the shape and size of the femoral head and the femoral-acetabular relationship from computer images of anteroposterior and lateral radiographs with the help of image-analysis software. METHODS Radiographs of 121 skeletally mature individuals with healed Legg-Calvé-Perthes disease were analyzed, and the sphericity deviation score, femoral head enlargement, femoral neck growth inhibition, and composite femoral congruency arc were calculated. RESULTS Each of these measurements was reproducible, with distinctly different values for hips in each of the Stulberg classes. Measures of sphericity and congruence (the sphericity deviation score and the composite femoral congruency arc) could very clearly discriminate between spherical and aspherical hips, and there was a strong correlation between these two measurements. CONCLUSIONS The study shows that it is possible to have reliable quantitative measures of the outcome of Legg-Calvé-Perthes disease at skeletal maturity.

To what extent does remodeling of the proximal femur and the acetabulum occur between disease healing and skeletal maturity in Perthes disease? A radiological study.

Radiographs of 75 children with unilateral disease were studied to quantify the extent of remodeling of the proximal femur and the acetabulum between healing and skeletal maturity in children with Perthes disease. The mean ages at disease onset, healing, and skeletal maturity were 8.3, 11.9, and 15.5 years, respectively. Fifty-seven children were treated surgically by subtrochanteric varus osteotomy with trochanteric epiphyseodesis; the remaining 18 children were treated nonoperatively. Assessment of the Moses index and Stulberg grading and measurements of the proximal femur and the acetabulum were made at healing and at skeletal maturity. The Stulberg grade and the Moses index did not change between healing and skeletal maturity in 88% and 95% of children, respectively. In operated children, there was significant improvement of the articulotrochanteric distance, acetabular depth, neck-shaft angle, and Sharps angle between disease healing and skeletal maturity, but no such changes occurred in children who were not operated on. We conclude that because little change occurs in the shape of the femoral head and congruity of the hip between healing and skeletal maturity, the outcome of treatment based on these 2 variables can be assessed once the disease heals in children with late-onset Perthes disease.

The Sphericity Deviation Score: A Quantitative Radiologic Outcome Measure of Legg-Calve´ Perthes Disease Applicable at the Stage of Healing and at Skeletal Maturity

Aim: This study aimed to determine if a new measure of sphericity of the femoral head, the Sphericity Deviation Score (SDS), could be estimated reliably at the stage of healing of Legg-Calvé-Perthes disease (LCPD) and to determine if the SDS at the healing stage reflects the outcome at skeletal maturity. Methods: The SDS was measured with image analysis software on radiographs of 120 children with unilateral LCPD at healing of the disease and at skeletal maturity. The reproducibility of measurement was assessed. SDS values for hips in different Stulberg classes were calculated. On the basis of SDS values at healing of 82 children, a logistic regression model was developed to determine the probability of a good outcome at skeletal maturity. The validity of the model was tested on another 38 children. Results: The SDS values at the stage of healing and at skeletal maturity were comparable. The SDS values were lowest for Stulberg Class I hips and highest for Class IV and V hips. The validated regression model showed a very high probability of a good outcome (Stulberg Class I or II) at skeletal maturity if the SDS at the stage of healing was below 10. Conclusions: A reliable estimate of the outcome of LCPD at skeletal maturity can be made by computing the SDS as soon as the disease heals.

The fate of the hip in spondylo-epi-metaphyseal dysplasia: clinical and radiological evaluation of adults with SEMD Handigodu type

PurposeThis study was undertaken to document the fate of the hip with reference to its structure and function in patients with spondylo-epi-metaphyseal dysplasia tarda Handigodu type (SEMDHG).Material and methodsRadiographs of 271 adult patients with SEMDHG were studied to identify the pattern of long-term sequelae in the hips. Several measurements of the proximal femur and acetabulum were made to quantify morphological alterations in the hip. Fifty-four adult patients were examined and administered a questionnaire to evaluate the extent of disability attributable to the hips.ResultsThree patterns of changes in the hips were noted: 35% had acetabular protrusio, 33% had subluxation of the hip, and 32% had no protrusio or subluxation. Distinctly different anthropometric measurements and dimensional alterations around the hip were noted in these three patterns. Patients with protrusio were relatively tall while those with subluxation were the shortest. All the patients had developed degenerative arthritis of the hips by the fourth decade of life irrespective of the pattern of hip involvement. The reduction in the range of hip motion and fixed deformities were most severe in patients with protrusio. All the patients had significant disability and very low functional hip scores.ConclusionDegenerative arthritis of the hip develops in the majority of patients with SEMDHG; the symptoms are severe enough to warrant reconstructive surgery by the fourth decade of life. Protrusio or subluxation develops in a third of the patients each; both these complications will influence the surgical approach if total hip arthroplasty is planned.

Effective Treatment of Posttraumatic Osteonecrosis of the Body of the Talus by Subtalar Fusion in a Child

Fractures of the talus are extremely rare in children, with a reported frequency of 0.08% among all pediatric fractures1. Fractures of the body of the talus are even more uncommon in children, with very few cases reported in the literature2-4. Based on the understanding of the mechanisms of injury of various types of talar body fractures encountered in adults5,6, it has been suggested that displaced fractures of the talar body in children should be treated according to the same treatment principles for fractures in adults (i.e., by open reduction and internal fixation)4. However, no clear guidelines are available for treatment of the complications of these injuries in children, which include osteonecrosis and malunion3. We report the successful treatment of a malunited, displaced coronal shear fracture of the body of the talus with osteonecrosis, fixed hindfoot varus, and impingement of the talus on the anterior tibial margin in a child. Revascularization of the avascular body of the talus appeared to be facilitated with a subtalar arthrodesis. The parents of the child were informed that data concerning the case would be submitted for publication, and they provided consent. A seven-year-old boy had been involved in a traffic accident and had sustained injuries to the right knee and leg. An associated ankle injury had not been diagnosed at the time of admission, and during the period of hospitalization, he …