Análise do risco do escorregamento epifisário femoral proximal contralateral pelo escore de Oxford modificado

Background:The ability to estimate skeletal maturity using a hip radiograph does not yet exist, but may have utility in the treatment of scoliosis, slipped capital femoral epiphysis, and lower limb deformity. We sought to develop a fast, accurate, and reproducible method. Methods: Fourteen hip radiologic parameters were evaluated on serial anteroposterior hip radiographs from 3 years before to 2 years after the skeletal age associated with 90% of final height, a validated skeletal maturity definition which correlates with the timing of peak height velocity. The Greulich and Pyle (GP) left hand bone age was obtained for comparison. Stepwise linear regression and generalized estimating equation analyses were used to isolate key hip and demographic parameters, creating the "optimized Oxford" skeletal maturity system. The accuracy of the optimized Oxford system in predicting years from 90% of final height was evaluated and compared with systems of demographics only, the modified Oxford, demographics+modified Oxford, and demographics+GP. Results: A total of 284 hip radiographs from 41 girls (range: 7 to 15 y) and 38 boys (range: 9 to 17 y) were included. Following multivariate analyses, 5 of the original 14 hip radiographic parameters remained significant. The predictions made by the optimized Oxford model had greater accuracy and fewer outlier predictions (predictions > 1 y off from actual years from 90% of final height) than the demographics only and modified Oxford only models (P < 0.05 for all). The optimized Oxford model had greater prediction accuracy than the demographics+modified Oxford model, but similar rates of outlier predictions (P = 0.903). No differences in mean prediction accuracy or rate of outlier predictions were observed between the optimized Oxford and the demographics+GP model (P > 0.05). Conclusion: High precision in skeletal maturity estimation can be achieved by using chronological age, sex, and 5 hip radiographic parameters. Clinical Relevance: We have developed a skeletal maturity system that utilizes anteroposterior hip radiographs and performs as accurately as GP.

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Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on AP Hip Radiographs

Furdock

Benedick

Nelson

et al. 2021

Journal of Pediatric Orthopaedics

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Modified Oxford Bone Scores Are Reduced in Patients With Slipped Capital Femoral Epiphysis Compared With Healthy Controls

Pflug

Herrero

Zhong

et al. 2021

Journal of Pediatric Orthopaedics

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Background: The etiology and pathogenesis of slipped capital femoral epiphysis (SCFE) are attributable to abnormalities of the proximal femoral epiphysis. This study aimed to examine if there is a difference in the bone age of patients diagnosed with SCFE compared with patients without hip pathology. Methods: We identified a consecutive series of patients treated for SCFE between December 2012 and December 2019 from a departmental database. Retrospective chart review was performed to collect demographic information and patient medical history. We then obtained a control group of statistically similar patients based on age and sex. These patients did not have hip pathology or medical comorbidities that could alter their bone age. The modified Oxford bone score (mOBS) was calculated for both groups by 3 blinded reviewers. We excluded patients with unstable slips, endocrine disorders, and inadequate imaging. Results: We identified 60 patients with stable idiopathic SCFE during the study period; 45 met inclusion criteria and were included in the final analysis. There were 27 males and 18 females. The average age of patients with SCFE was higher in males than females (12.6 vs. 11.1, P < 0.01). Patients in the comparison cohort did not differ significantly from the SCFE cohort in terms of age (11.6 vs. 12.0, P = 0.06) or sex (P = 0.52). The comparison group's median mOBS was significantly higher than the SCFE group (22.5 vs. 20.5, P < 0.01). The difference in the mOBS between male and female patients in the SCFE group approached significance (20.0 vs. 21.0, P = 0.05). The weighted κ coefficient was 0.93. Conclusions: Patients with SCFE have a decreased bone age compared with patients without hip pathology. Male patients with SCFE were more likely to be older compared with female patients.

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Análise do risco do escorregamento epifisário femoral proximal contralateral pelo escore de Oxford modificado

Cited by 2 publications

References 19 publications

Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on AP Hip Radiographs

Systematic Isolation of Key Parameters for Estimating Skeletal Maturity on AP Hip Radiographs

Modified Oxford Bone Scores Are Reduced in Patients With Slipped Capital Femoral Epiphysis Compared With Healthy Controls

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