Clin Orthop Surg.  2014 Jun;6(2):223-229. 10.4055/cios.2014.6.2.223.

What Is the Usefulness of the Fragmentation Pattern of the Femoral Head in Managing Legg-Calve-Perthes Disease?

• Kim HT
• Woo SH
• Jang JH
• Lee SG
• Kim HK
• Browne R

• KMID: 1784671
• DOI: http://doi.org/10.4055/cios.2014.6.2.223

Abstract

BACKGROUND
Within the lateral pillar classification of the Legg-Calve-Perthes (LCP) disease, hips seem quite variable in the pattern of fragmentation as seen in radiographs. The purpose of this study was to determine: if it is possible to reliably subdivide the lateral pillar groups into femoral head fragmentation patterns, and if such a subdivision of the lateral pillar groupings is clinically useful in managing LCP disease.
METHODS
Two hundred and ninety-three anteroposterior radiographs taken at the maximal fragmentation stage (189 lateral pillar B, 57 B/C border, and 47 C hips; mean bone/chronologic age at the time of first visit, 6.2/7.9 years) and at skeletal maturity (mean age, 16.6 years) were analyzed. We distinguished 3 fragmentation patterns in each pillar group based on the region of major involvement. We tested the inter- and intraobserver reliability of our classification system and analyzed the relationships between the fragmentation patterns and the Stulberg outcomes as well as other factors such as surgical treatment and age.
RESULTS
Inter- and intraobserver consistency in fragmentation pattern assignments was found to be substantial to excellent. A statistically significant trend (p = 0.001) in the proportion of Stulberg III or IV outcomes in comparison with Stulberg I and II was only found for the different fragmentation patterns in our lateral pillar B patients: fragmentation patterns having mainly lateral-central necrosis led to poor outcomes. No significant association was found between fragmentation patterns and Stulberg outcomes in pillar groups B/C border and C.
CONCLUSIONS
Our results are consistent with the lateral pillar classification itself. Therefore, fragmentation patterns in each lateral pillar classification did not provide clinical usefulness in the management of LCP disease.

Keyword

Lateral pillar classification; Fragmentation pattern; Stulberg outcomes

MeSH Terms

Adolescent
Child
Femur Head/*radiography
Femur Head Necrosis/classification/radiography
Humans
Legg-Calve-Perthes Disease/*classification/radiography
Observer Variation
Prognosis
Retrospective Studies
Young Adult

Figure

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  Fig. 1 Fragmentation patterns (and examples) in a lateral pillar B Legg-Calvé-Perthes disease. (A) Pattern 1, necrosis primarily central. (B) Pattern 2, necrosis medial and central. (C) Pattern 3, necrosis lateral and central.

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  Fig. 2 Fragmentation patterns (and examples) in a lateral pillar C Legg-Calvé-Perthes disease. (A) Pattern 1, ossific nucleus evenly flattened. (B) Pattern 2, necrosis mainly lateral. (C) Pattern 3, entire ossific nucleus fragmented.

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