Ismail and Macnicol developed a prognostic score for patients with Legg-Calve-Perthes disease. They incorporated 3 factors known to correlate with outcome. The authors are from the Princess Margaret Rose Orthopaedic Hospital in Edinburgh.
Parameters for the combined score:
(1) arthrographic contour of the femoral head
(2) Herring grade (lateral pillar classification)
(3) age of disease onset (the older the age of onset, the worse the prognosis)
|
Parameter |
Finding |
Points |
|
arthrographic contour of the femoral head |
spherical |
1 |
|
|
mildly deformed |
2 |
|
|
moderately deformed |
3 |
|
|
severely deformed |
4 |
|
Herring grade |
grade A |
1 |
|
|
grade B |
2 |
|
|
grade C |
3 |
|
age of onset |
< 5 years of age |
1 |
|
|
5 to 6 years of age |
2 |
|
|
6 to 7 years of age |
3 |
|
|
> 7 years of age |
4 |
where:
• "Greater than 7 years of age" for the age of onset could either mean (a) 8 years of age or older, or (b) anytime after the 7th birthday. I used (b) in the implementation.
combined score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 3
• maximum score: 11
• The higher the score, the more severe the disease and the worse the prognosis.
• The combined scored tended to parallel the Stulberg score which correlates with outcome.
|
Combined Score |
Stulberg Score 1 |
Stulberg Score 2 |
Stulberg Score 3 |
Stulberg Score 4 |
|
3 |
100% |
0% |
0% |
0% |
|
4 |
78% |
22% |
0% |
0% |
|
5 |
69% |
23% |
8% |
0% |
|
6 |
22% |
72% |
6% |
0% |
|
7 |
22% |
44% |
34% |
0% |
|
8 |
14% |
0% |
86% |
0% |
|
9 |
0% |
22% |
67% |
11% |
|
10 |
0% |
0% |
100% |
0% |
|
11 |
0% |
0% |
0% |
100% |
from Table II, page II
Specialty: Surgery, orthopedic
