In summary, because the number of these injuries is on the rise, it is important for the physician to be aware of the clinical manifestations of overuse injuries, to prescribe current recommended treatments, and to educate patients in proper athletic conditioning.

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The purpose of this study was to assess interobserver and intraobserver variability in the assessment of clinical and radiographic measurement of lower limb length discrepancy. Clinical measurements included direct measurement with a tape measure from anterior superior iliac spine (ASIS) to lateral malleolus and ASIS to medial malleolus as well as block measurement. Slit scanogram radiographic measurement was also evaluated. All three clinical measurements had excellent reliability, but the relatively large mean differences and the large 95% confidence intervals for clinical measurements limit the usefulness of these techniques. Slit scanogram measurement was the most reliable measurement technique. The intraobserver variance of direct slit scanogram measurement included intraclass correlation coefficient of 0.99, mean difference of 0.1 cm, and 95% confidence interval of 0.4 cm. Results were not influenced by patient age or body mass index. Slit scanogram measurement is the preferred method for assessment of limb length discrepancy. The direct slit scanogram measurement described in the text follows the mechanical axis line of the leg in the "at ease" standing position described by Paley. Direct measurement using a measuring tape on a full-length slit scanogram is more reliable than indirect measurement using horizontal lines drawn to a radiolucent ruler that is positioned by a technician, since direct measurement avoids errors due to nonparallel positioning of the limb relative to the ruler, and direct measurement also avoids errors due to non-horizontal lines drawn from standard bony landmarks to the ruler. The ideal radiographic measurement technique would have high reliability and accuracy and would minimize or eliminate radiation.

Background: Hand radiographs for skeletal maturity staging are now frequently used to evaluate remaining growth potential for patients with adolescent idiopathic scoliosis (AIS). Our objective was to create a model predicting a patient's risk of curve progression based on modern treatment standards. Methods: We retrospectively reviewed all AIS patients presenting with a major curve <50 degrees, available hand radiographs, and complete follow up through skeletal maturity at our institution over a 3-year period. Patients with growth remaining underwent rigid bracing of curves > 25 degrees, whereas patients between 10 and 25 degrees were observed. Treatment success was defined as reaching skeletal maturity with a major curve <50 degrees. Four risk categories were identified based on likelihood of curve progression.Results: Of 609 AIS patients (75.4% female) presenting with curves over 10 degrees and reaching skeletal maturity at most recent follow up, 503 (82.6%) had major thoracic curves. 16.3% (82/503) of thoracic curves progressed into surgical treatment range. The highest risk group (Sanders 1 to 6 and curve 40 to 49 degrees, Sanders 1 to 2 and curve 30 to 39) demonstrate a 30% success rate with nonoperative treatment. This constitutes an 111.1 times (95% confidence interval: 47.6 to 250.0, P < 0.001) higher risk of progression to surgical range than patients in the lowest risk categories (Sanders 1 to 8 and curve 10 to 19 degrees, Sanders 3 to 8 and curve 20 to 29 degrees, Sanders 5 to 8 and curve 30 to 39 degrees). Conclusions: Skeletal maturity and curve magnitude have strong predictive value for future curve progression. The results presented here represent a valuable resource for orthopaedic providers regarding a patient's risk of progression and ultimate surgical risk.