Clinical Validation of the Multiplier Method for Predicting Limb Length Discrepancy and Outcome of Epiphysiodesis, Part II

Abstract

To validate the accuracy of the multiplier method in predicting limb length discrepancy (LLD) and outcome of epiphysiodesis, radiographs of 60 patients treated for LLD were measured. Data generated were used to predict maturity lengths of epiphysiodesed limbs, bone length discrepancies at maturity, and LLD at maturity after epiphysiodesis (residual discrepancy) using the multiplier and Moseley methods. The multiplier method mean error for bone length discrepancies predictions was 0.6 cm (SD = 0.6). Mean error for predicting lengths of epiphysiodesed limbs was 1.6 cm (SD = 1.2) for both methods. Mean errors for predicting residual discrepancies were 0.9 cm for the multiplier method using chronologic age, 1 cm for the multiplier method using skeletal age, and 1.3 cm for the Moseley method. Mean error difference between the methods was significant (P = 0.0008). The multiplier method accurately predicts LLD and outcome of epiphysiodesis and is more accurate than the Moseley method in predicting LLD at maturity after epiphysiodesis.

CORR Insights®: Paley's Multiplier Method Does Not Accurately Predict Adult Height in Children with Bone Sarcoma

“…The results of the present study are similar to that of Aguilar et al [1,2], who noted that the multiplier method erred as much as 4.4 cm when predicting adult heights for boys and 2.6-cm for girls 5-years-old and younger. Another study by Sanders et al [8] showed that use of the multiplier method can cause errors as great as 5 cm when used in patients who already had their growth spurt.…”

Treatment of pediatric patients with lower leg deformities associated with physeal arrest: analysis of 28 cases

“…В нашей работе мы использовали метод прогнозирования роста Multiplier, который лежит в основе работы компьютерного прило-жения для iPhone PaleyGrowth. Согласно данным D. Paley et al указанный метод достаточно точно определяет неравенство длин конечностей по до-стижении костной зрелости [32]. Величину пере-удлинения мы рассчитывали, исходя из насто-ящей длины сегмента и прогнозируемой длины здорового сегмента по достижении им костной зрелости.…”

Possible mistakes in prediction of bone maturation in fibular hemimelia by Moseley chart

“…Aguilar et al found that the Moseley method is as accurate as the multiplier method in predicting bone maturity lengths but less accurate in predicting limb length discrepancies at maturity after epiphyseodesis [26,27]. Dewaele and Fabry were not able to significantly improve their results in timing the skeletal age for epiphyseodesis by using the Moseley straight-line graph, and their principal source of error was in estimating the bone age [3].…”