Good inter- and intraobserver reliability for assessment of the slip angle in 77 hip radiographs of children with a slipped capital femoral epiphysis

Herngren, Bengt; Lindell, Mikael; Hägglund, Gunnar

doi:10.1080/17453674.2017.1409941

Cited by 8 publications

(8 citation statements)

References 28 publications

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“…Furthermore, the radiographic assessments and measurements were performed by a resident orthopedic surgeon and not a radiologist. Studies have shown good inter-observer reliability for radiographic measurements between observers with varying experience (Tiderius et al 2004, Herngren et al 2018 and that radiologic technologists with appropriate training can interpret radiographs accurately (Piper et al 2005, Woznitza et al 2018. In our study, the observer had extensive training prior to the data collection and continuous support from senior orthopedic consultants during the readings.…”

Section: Discussionmentioning

confidence: 99%

Hip dysplasia is not uncommon but frequently overlooked: a cross-sectional study based on radiographic examination of 1,870 adults

Leide

Bohman²,

Wenger

et al. 2021

Acta Orthopaedica

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Section: Discussionmentioning

confidence: 99%

Hip dysplasia is not uncommon but frequently overlooked: a cross-sectional study based on radiographic examination of 1,870 adults

Leide

Bohman²,

Wenger

et al. 2021

Acta Orthopaedica

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“…For slip angle, intraclass correlation coefficients (ICC) for inter-rater reliability has been reported to be 0.98 with intrarater reliability having a mean difference below 1 degree. 17 A second study found slip angle to have an interrater reliability ICC of 0.97 and intrarater reliability of 0.989. 12 Cohen's quadratic weighted kappa statistic has been used to describe reliability for measurements of the screw within the epiphysis.…”

Section: Methodsmentioning

confidence: 94%

“…Intrarater and inter-rater reliabilities were not calculated, as we do not describe a novel radiographic measurement and reliabilities have been previously reported for the measurements used. For slip angle, intraclass correlation coefficients (ICC) for inter-rater reliability has been reported to be 0.98 with intrarater reliability having a mean difference below 1 degree 17. A second study found slip angle to have an inter-rater reliability ICC of 0.97 and intrarater reliability of 0.989 12.…”

Section: Methodsmentioning

confidence: 98%

Factors Affecting Slip Progression After In Situ Screw Fixation of Stable Slipped Capital Femoral Epiphysis

Makarewich

Wait

Fedorak

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Slip progression after in situ fixation of slipped capital femoral epiphysis (SCFE) has been reported as occurring in up to 20% of patients. We review SCFE treated with in situ single screw fixation performed at 2 hospitals over a 15-year period to determine the factors associated with slip progression. Methods: This case-control study reviews SCFE treated with in situ single cannulated screw fixation with minimum follow up of 1 year and full closure of the affected physis. Slip progression (failure) was defined as worsening of the Southwick slip angle of 10 or more degrees or revision surgery for symptomatic slip progression. Univariate and multivariate analyses were performed comparing success and failure groups for patient characteristics, screw type and position, and radiographic measurements. Results: Ninety three patients with 108 slips met all criteria, with 15 hips (14%) classified as having slip progression (failure). All failures had 3 threads or fewer across the physis. Five hips had 2 threads across the physis, and 4 of the 5 were classified as failures. Lower modified Oxford bone scores were found in the failure group, though the difference was small (0.9, P = 0.013). Failure was also associated with partially threaded screws (P = 0.001). Failed hips were associated with lower initial Southwick angles (32.8 degrees) than successful hips (40.4 degrees) (P = 0.047). In the stepwise model for multivariate regression, 4 factors were identified as significant, with lower initial number of threads (P < 0.0001), mild initial Southwick category (P = 0.0050), male sex (P = 0.0061), and partially threaded screw type (P = 0.0116) predicting failure. Conclusion:This study is the largest to date evaluating risk factors for slip progression after SCFE fixation, and the first to consider revision surgery for symptomatic slip progression. For stable SCFE, we demonstrate that 4 threads across the physis with a fully threaded screw of 6.5 mm diameter or greater was sufficient to avoid slip progression. We provide a risk stratification for progression of slip showing that in some cases 3 threads across the physis may be sufficient. Level of Evidence: Level III-case-control study.

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“…High intraobserver and interobserver reliability of the epiphyseal shaft angle on radiographic analysis of the slipped capital femoral epiphysis in humans have previously been reported. 10 Additionally, we calculated intraclass and interclass correlation coefficients, finding good reliability between readers. All measurements were performed twice by one examiner and once by another examiner.…”

Section: Methodsmentioning

confidence: 98%

A Novel Model of Hip Femoroacetabular Impingement in Immature Rabbits Reproduces the Distinctive Head-Neck Cam Deformity

et al. 2022

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Background: Femoroacetabular impingement (FAI) is a leading cause of hip pain in young adults and often leads to degenerative osteoarthritis (OA). A small animal model of hip deformities is crucial for unraveling the pathophysiology of hip OA secondary to FAI. Purposes: To (1) characterize a new minimally invasive surgical technique to create a proximal femoral head–neck deformity in a skeletally immature rabbit model and (2) document the effect of an injury to the medial proximal femoral epiphysis on head–neck morphology at 28 days after the injury. Study Design: Controlled laboratory study. Methods: Six-week-old New Zealand White rabbits (n = 10) were subjected to right hip surgery, with the left hip used as a control. An epiphyseal injury in the medial femoral head was created using a 1.6-mm drill. Hips were harvested bilaterally at 28 days after surgery. Alpha and epiphyseal shaft angles were measured on radiographs. Alpha angles at the 1- and 3-o’clock positions were measured on the oblique axial plane of micro–computed tomography images. Bone bar formation secondary to growth plate injuries was confirmed using alcian blue hematoxylin staining. Results: All hips in the study group showed a varus–type head-neck deformity, with lower epiphyseal shaft angles on anteroposterior radiographs versus those in the control group (133°± 8° vs 142°± 5°, respectively; P = .022) and higher epiphyseal shaft angles on lateral radiographs (27°± 12° vs 10°± 7°, respectively; P < .001). The mean alpha angles in the study group were higher at both the 1- (103°± 14° vs 46°± 7°, respectively; P < .002) and 3-o’clock (99°± 18° vs 35°± 11°, respectively; P < .002) positions than those in the control group. Alcian blue hematoxylin staining of all hips in the study group indicated that the injured physis developed a bony bar, leading to growth plate arrest on the medial femoral head. Conclusion: The proposed model led to growth arrest at the proximal femoral physis, resulting in a femoral head–neck deformity similar to human FAI. Clinical Relevance: Our novel small animal model of a femoral head–neck deformity is a potential platform for research into the basic mechanisms of FAI disease progression and the development of disease–modifying therapies.

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Good inter- and intraobserver reliability for assessment of the slip angle in 77 hip radiographs of children with a slipped capital femoral epiphysis

Cited by 8 publications

References 28 publications

Hip dysplasia is not uncommon but frequently overlooked: a cross-sectional study based on radiographic examination of 1,870 adults

Hip dysplasia is not uncommon but frequently overlooked: a cross-sectional study based on radiographic examination of 1,870 adults

Factors Affecting Slip Progression After In Situ Screw Fixation of Stable Slipped Capital Femoral Epiphysis

A Novel Model of Hip Femoroacetabular Impingement in Immature Rabbits Reproduces the Distinctive Head-Neck Cam Deformity

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