| A modification of Klein's Line to improve sensitivity of the anterior-posterior radiograph in slipped capital femoral epiphysis. | |
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MedLine Citation:
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PMID: 19568015 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Radiographs can diagnose slipped capital femoral epiphysis (SCFE) on the anterior-posterior (AP) pelvis view and the frog-leg lateral view of the hips. On the AP radiograph, the lack of intersection between a line drawn parallel to the superior edge of the femoral neck (Klein's Line) and the epiphysis confirms a slip. Despite broad knowledge of the Klein's Line principle, application is difficult and inaccurate, especially in mild cases. On the frog-leg lateral radiograph, Southwick head/shaft angle and Wilson percent epiphyseal displacement commonly quantify the slip. Here, we set out to evaluate the intraobserver and interobserver reliability and the efficacy of these methods. METHODS: Five separate observers on 2 separate occasions evaluated 30 AP and 30 frog-leg lateral radiographs of patients with unilateral SCFE for head/shaft angle, percent epiphyseal displacement, and width of epiphysis lateral to Klein's Line. RESULTS: We calculated the minimum difference required for 2 measurements to be considered different with 95% confidence ("minimum agreement difference"). For head/shaft angle, the intraobserver minimum agreement difference was +/-7.27 degrees and the interobserver +/-8.80 degrees; for percent epiphyseal displacement, the intraobserver was +/-7.18% and the interobserver was +/-7.27%; and for width of epiphysis lateral to Klein's Line, the intraobserver was +/-1.98 mm and the interobserver +/-2.16 mm. For each of these measures, the slipped hips significantly differed from the control hips (P<0.001 in all cases). Our analysis of the classical definition of Klein's Line--the lack of intersection between Klein's Line and the epiphysis as a sign of a slip--identified only 40.3% of slips. By modifying Klein's Line such that we measure the width of epiphysis lateral to Klein's Line, we improved sensitivity to 79% if a difference of 2 mm between hips indicated a slip. CONCLUSIONS: On the basis of our findings, head/shaft angle and percent epiphyseal displacement provide reliable and efficacious means of radiographic SCFE diagnosis. The classic definition of Klein's line fails to identify 60% of slips. We propose a modification of Klein's Line to improve sensitivity. |
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Authors:
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Daniel W Green; Ngozi Mogekwu; David M Scher; Sheryl Handler; Peter Chalmers; Roger F Widmann |
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Publication Detail:
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Type: Evaluation Studies; Journal Article |
Journal Detail:
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Title: Journal of pediatric orthopedics Volume: 29 ISSN: 1539-2570 ISO Abbreviation: J Pediatr Orthop Publication Date: 2009 Jul-Aug |
Date Detail:
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Created Date: 2009-07-01 Completed Date: 2009-09-23 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8109053 Medline TA: J Pediatr Orthop Country: United States |
Other Details:
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Languages: eng Pagination: 449-53 Citation Subset: IM |
Affiliation:
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Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell, New York, NY 10021, USA. greendw@hss.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Child Epiphyses, Slipped / diagnosis, radiography* Female Femur Head / pathology, radiography* Femur Neck / pathology, radiography* Humans Male Observer Variation Reproducibility of Results Sensitivity and Specificity |
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