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Children's Orthopaedics

LEGG-CALVE-PERTHES: INTEROBSERVER AND INTRAOBSERVER RELIABILITY OF THE MODIFIED HERRING LATERAL PILLAR CLASSIFICATION

British Society for Children's Orthopaedic Surgery (BSCOS) and British Limb Reconstruction Society (BLRS)



Abstract

The purpose of our study was to independently assess the modified Herring lateral pillar classification.

Methods and results

35 standardised true antero-posterior radiographs of children in various stages of fragmentation were independently assessed by 6 senior observers on 2 separate occasions (6 weeks apart). Kappa analysis was used to assess the inter and intraobserver agreement between observations made. Intraobserver analysis revealed at best only moderate agreement for two observers. 3 observers showed fair consistency, whilst 1 remaining observer showed poor consistency between repeated observations (p<0.01). The highest scores for interobserver agreement varying between moderate to good could only be established between 2 observers. For the remaining observers results were just fair (p<0.01).

Conclusion

This stdy highlights the lack of agreement between senior clinicians when applying the modified LPC. This clearly has clinical implications. To our knowledge this is the first time the modified lateral pillar classification has been independently tested for its reproducibility by a specialist orthopaedic unit.