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ISSN 2007-087X (Print)
Órgano Oficial de la Sociedad Mexicana de Ortopedia Pediátrica

2009, Number 1

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Rev Mex Ortop Ped 2009; 11 (1)

Prognostic factors associated with a catastrophic result

Testas HM, Mijares J, Castañeda P

Language: Spanish
References: 40
Page: 14-20
PDF size: 187.38 Kb.


ABSTRACT

Introduction: Certain patients with Legg-Calvé-Perthes disease (LCPD) will evolve in a catastrophic fashion despite the treatment implemented; this is considered when there is persistent pain in the short-term with limited range of motion and a limp. A factor for poor prognosis is not always found; we sought to determine if there were any risk factors that could be associated with a catastrophic result. Material and method: This was a retrospective review of 98 patients with LCPD; the Iowa hip score was used to grade outcome and a catastrophic result was considered when the score was below 60 points. We studied sex, age at presentation, the lateral pillar classification, the initial range of motion and the treatment implemented in each patient as independent variables to determine if any one of them had a relationship with the final result. Results: Of the 98 patients we found 13 (14 hips) with a catastrophic result, 2 were girls and 11 boys, the mean age at presentation was 6.3 years. According to the lateral pillar classification 5 hips were type B and 9 were type C. The mean initial abduction for the group with a catastrophic result was 29° whereas for the other patients it was 44° (p = 0.04). With regards to treatment, 2 patients had been treated with physical therapy alone, 2 with a course of skin traction followed by physical therapy and 10 underwent diverse surgical procedures. The only independent variable found to have a significant difference between the groups was the initial abduction. Discussion: patients with LCPD have variable outcomes and it is difficult to provide an accurate prognosis on the initial visit. We found that the only indicator of a poor prognosis was limited initial abduction. Level of evidence: IV prognostic study.


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