Gage’s sign, metaphyseal cysts may predict Legg-Calvé-Perthes disease
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Head-at-risk signs, such as Gage’s sign and metaphyseal cysts, are risk factors that may predict poor prognoses in pediatric patients with Legg-Calvé-Perthes disease, according to presented results.
“The treatment and prognosis of patients with Legg-Calvé-Perthes disease (LCPD) is still a question mark,” Serkan Erkus, from the department of orthopaedics and traumatology at Izmir Health Sciences University in Turkey, said in his presentation at the Virtual EFORT Congress.
“Radiological findings, which were determined by Catterall, and predicting that the disease may have a poor prognosis guide us in this regard,” Erkus said. “In this study, the relationship between the head-at-risk signs in LCPD and the predictive prognosis was quantitatively investigated with intra- and inter-observers.”
In their descriptive, cross-sectional study, Erkus and colleagues evaluated 195 total patients, 94 of which were diagnosed with LCPD. Researchers categorized the patients into a junior group, which consisted of patients younger than 10 years, and a senior group, which consisted of patients older than 10 years.
According to the study, Erkus and colleagues asked three pediatric orthopaedists to perform monthly screening of the patients for risk factors such as, anteroposterior and frog-leg X-rays, age and hip range of motion. They asked the pediatric orthopaedistss to determine LCPD signs, stage of recovery (as defined by the Stulberg classification) and to predict each patient’s prognosis.
After deriving both intra-and inter-observer agreement using percentage agreement, Gwet’s AC1 and Pearson and Kendall’s Tau-b, Erkus and colleagues determined there was a “statistically significant correlation” between the number of risks observed, forecast of Stulberg stage of recovery and prognosis prediction.
Researchers found the highest intra-observer agreement for Gage’s sign, which was 0.58 in the senior group and 0.26 in the junior group, and for metaphyseal cysts, which was 0.53 in the senior group and 0.20 in the junior group. Additionally, Erkus noted the least observed agreement was for lateral subluxation of the femoral head.
“The most compatible risk signs in both groups were Gage’s sign and metaphyseal cyst, respectively,” Erkus concluded. “Minimal agreement was obtained for superolateral migration. Inter-observer agreement of all five risk signs was at least moderate. The increase in the number of Catterall head-at-risk signs has been observed to be an effective factor both in predicting prognosis and deteriorating Stulberg stage,” he added.
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Erkus S, et al. Paper 1936. Presented at: Virtual EFORT Congress; Oct. 28-30, 2020.
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