Original Research
Reproducibility of Radiographic Measurements in Assessment of Congenital Talipes Equinovarus
Am J Orthop. 2009 December;38(12):617-620
Author and Disclosure Information
John Thometz, MD, Robert Manz, MD, Xue-Cheng Liu, MD, PhD, John Klein, PhD, and Barbara Manz-Friesth, DNS, RN
Dr. Thometz is Chief of Pediatric Orthopedics, Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin, and Professor, Medical College of Wisconsin, Milwaukee, Wisconsin.
Dr. Manz is Resident, Medical College of Wisconsin, Milwaukee, Wisconsin.
Dr. Liu is Associate Professor, Department of Orthopaedic Surgery, Medical College of Wisconsin, and Director, MusculoSkeleton Functional Assessment Center, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
Dr. Klein is Professor and Director, Department of Population Health Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Dr. Manz-Friesth is Associate Professor, Indiana University School of Nursing, Indianapolis, Indiana.
Six commonly measured parameters in the assessment of congenital clubfoot were retrospectively assessed from standardized preoperative and intraoperative radiographs taken during operative complete subtalar release. These radiographic parameters were measured in 30 feet by 6 observers at 2 separate readings. The observers were orthopedic residents in different stages of training. Between- observers intraclass correlation coefficients (ICCs) were computed for each parameter. All radiographic parameters were found to be reproducible across time and observers (range of preoperative intraobserver ICCs, 0.84-0.99; range of preoperative interobserver ICCs, 0.93-0.99), except for intraoperative anteroposterior (AP) talar–first metatarsal angle (intraoperative intraobserver ICC, 0.79) and lateral talocalcaneal angle (intraoperative interobserver ICC, 0.81). Differences in mean preoperative measurements between observers and time were tested by analysis of variance. There were no significant differences between observers and time in the 6 preoperative measurements (P>.05), except for intraoperative AP talar–first metatarsal angle, AP talocalcaneal angle, and degree of AP calcaneocuboid subluxation, which were significantly different (P<.05). Our results support use of radiographs as a reliable method for guiding care in patients with clubfoot and as a reproducible method that physicians can use for comparisons.