The Use of Proximal Femur Maturity Index in Guiding Brace Weaning for Adolescent
Idiopathic Scoliosis
#MMPMID41210905
Cheung PWH
; Canavese F
; Wong JSH
; Luk KDK
; Cheung JPY
JB JS Open Access
2025[Oct]; 10
(4
): ? PMID41210905
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BACKGROUND: For adolescent idiopathic scoliosis, whether the Proximal Femur
Maturity Index (PFMI) can guide brace-wear weaning remains unknown. The aim of
this study was to investigate whether PFMI gradings at brace weaning were related
to curve progression after brace treatment and to evaluate the postweaning curve
progression risk associated with PFMI gradings. METHODS: This prospective study
included 137 patients who were advised to wean from underarm bracing with
adequate compliance. They were followed up for at least 2 years. Data collection
included bodily growth parameters, curve magnitude, and skeletal maturity status
at weaning as assessed by PFMI, distal radius and ulna classification, and Risser
and Sanders staging. Curve progression was defined as >6° major curve increase at
postweaning 2 years. Relationships between PFMI and other skeletal maturity
gradings, and whether parameters at weaning were associated with curve
progression were investigated. RESULTS: There were 59.1% (n = 81) of patients who
weaned bracing at PFMI grade 5, 39.4% at grade 6, and 1.5% at grade 4. PFMI
gradings correlated with radius (G = 0.596, p < 0.001), ulnar (G = 0.700, p <
0.001), and Sanders (G = 0.689, p < 0.001) stages. 11.7% of the patients
experienced curve progression. Curve progression rate was 0% for those who weaned
at PFMI grade 6, or PFMI grade 5 with Risser stage 5 or ? R10 U9 for <30° curves.
Compared with PFMI grade 4 or 5, weaning at grade 6 reduced progression risk by
29.7% (95% Confidence Interval [CI] 13.3-43.0, p = 0.023) for curves ?30°, while
relative risk reduction was 10.9% (95% CI 1.4-19.4, p = 0.037) for <30° curves.
CONCLUSIONS: For patients who were prescribed bracing for their 25° to 40° curves
with adequate compliance, PFMI grade 6 can serve as an independent indicator for
guiding brace weaning with minimal curve progression risk.
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