Article2005

Measurement Variance in Limb Length Discrepancy

Michael A. Terry · Jennifer J. Winell · Daniel W. Green · Robert J. Schneider · Margaret G. E. Peterson · Robert G. Marx +1 more

88 citations0/0 files storedJournal of Pediatric Orthopaedics

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Abstract

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.

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References

1986STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT 1965Akufo and Ibarapa 1995Comparing methods of measurement: why plotting difference against standard method is misleading 1990A note on the use of the intraclass correlation coefficient in the evaluation of agreement between two methods of measurement 1988Skeletal Age Estimation in Leg Length Discrepancy

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2007Reliability Analysis for Radiographic Measurement of Limb Length Discrepancy 2013Validity of measuring leg length with a tape measure compared to a computed tomography scan 2011Reliability and accuracy of the tape measurement method with a nearest reading of 5 mm in the assessment of leg length discrepancy.2008Estimation of stature and length of limb segments in children and adolescents from whole-body dual-energy X-ray absorptiometry scans 2019A systematic review on the validity and reliability of tape measurement method in leg length discrepancy.2010The reliability of computed tomography scanograms in the measurement of limb length discrepancy 2006Measurement Variance in Limb Length Discrepancy: Clinical and Radiographic Assessment of Interobserver and Intraobserver Variability

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