Scanography for Leg-Length Measurement: An Easy Satisfactory Method

Pugh, David G.; Winkler, Norlin T.

doi:10.1148/87.1.130

Cited by 13 publications

(5 citation statements)

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“…The former was measured using a digital imaging system (PACS PetaVision version 2.1; AMC, Seoul, Korea), and the latter according to the method of slit scanogram. 14,15 The intra-and interobserver reliability were 0.818 and 0.801 for the diameter, and 0.875 and 0.822 for leg-length discrepancy, respectively. Both these values were statistically significant and demonstrated high reproducibility (p < 0.001).…”

Section: Methodsmentioning

confidence: 95%

Risk factors for overgrowth after flexible intramedullary nailing for fractures of the femoral shaft in children

2013

The Bone & Joint Journal

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We analysed retrospectively the risk factors leading to femoral overgrowth after flexible intramedullary nailing in 43 children (mean age 7.1 years (3.6 to 12.0)) with fractures of the shaft of the femur. We reviewed their demographic data, mechanism of injury, associated injuries, the type and location of the fractures, the nail-canal diameter (NCD) ratios and femoral overgrowth at a mean follow-up of 40.7 months (25.2 to 92.7). At that time, the children were divided into two groups, those with femoral overgrowth of < 1 cm (Group 1), and those with overgrowth of ≥ 1 cm (Group 2). The mean femoral overgrowth of all patients was 0.6 cm at final follow-up. Overgrowth of ≥ 1 cm was noted in 11 children (25.6%). The NCD ratio was significantly lower in Group 2 than in Group 1, with an odds ratio of 30.0 (p = 0.003). We believe that a low NCD ratio is an indicator of an unstable configuration with flexible intramedullary nailing, and have identified an association between a low NCD ratio and femoral overgrowth resulting in leg-length discrepancy after flexible intramedullary nailing in paediatric femoral shaft fractures.

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Section: Methodsmentioning

confidence: 95%

Risk factors for overgrowth after flexible intramedullary nailing for fractures of the femoral shaft in children

2013

The Bone & Joint Journal

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“…Several methods exist for the radiographic assessment of leg length discrepancy, including teleoroentgenogram, 3 orthoroentgenogram, 4 slit scanogram, 5-7 CT scanogram, [5][6][7][8][9][10][11] and ultrasound. 12,13 The reliability of x-ray scanogram and that of CT scanogram have been studied extensively, with the two techniques showing similar reliability and accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…1 Clinical assessment of limb length discrepancy is notoriously unreliable, with block measurements widely believed to be the most reliable clinical measurement technique. 2,3 A variety of radiographic techniques have been developed, including teleoroentgenogram, 3 orthoroentgenogram, 4 plain radiographic slit scanogram, [5][6][7] CT scanogram, [8][9][10][11] and ultrasound. 12,13 Plain radiographic scanogram and CT scanogram have been shown to have extremely high reliability.…”

mentioning

confidence: 99%

Reliability and Accuracy of MRI Scanogram in the Evaluation of Limb Length Discrepancy

Leitzes¹,

Potter²,

Amaral³

et al. 2005

Journal of Pediatric Orthopaedics

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The purpose of this study was to compare MRI scanogram with traditional radiographic methods for measurement of limb length. The authors hypothesized that MRI scanogram would be as reliable and accurate as radiographic scanogram in measurement of limb length without exposing patients to ionizing radiation. Twelve cadaveric femurs were measured using AP conventional radiographic scanogram, CT scanogram, MRI scanogram, and electronic caliper. Three orthopaedists performed two separate measurements using each technique. Intraobserver and interobserver variability was assessed for each of the three radiographic techniques. Accuracy was assessed by comparison of radiographic measurements to electronic caliper measurements of femur length. The reliability of all three radiographic limb length measurement techniques was excellent (ICC > 0.99). The accuracy of plain radiographic scanogram was slightly superior to CT scanogram and MRI scanogram. The mean absolute differences for radiographic, CT, and MRI scanograms compared with the gold standard, direct caliper measurement, were 0.52 mm, 0.68 mm, and 2.90 mm, respectively. All three scanogram techniques showed excellent reliability and accuracy. Radiographic scanogram remains the gold standard for leg length measurement. MRI scanogram is slightly less accurate compared with radiographic scanogram, but it does not use ionizing radiation. MRI scanogram merits clinical study and comparison with the traditional radiographic scanogram method for measurement of limb length.

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“…In the present study, we used slit scanograms and standing slot-scanning radiographs to measure limb lengths. In our center, we have used the technique of leg-length measurement by slit scanography described by Pugh and Winkler 11 , in which the x-ray beam is collimated to a narrow slit and the tube moves over the patient’s lower extremities (Fig. 9).…”

Section: Discussionmentioning

confidence: 99%

“…Between 2008 and 2012, radiographs were made using a slit scanner protocol developed and validated at our center. Described by Pugh and Winkler 11 , this is the standardized method that has been used at our center since 1970. Patients who were unable to remain still for the biplanar slot-scanning imaging between 2013 and 2020 also underwent imaging with the use of the supine slit scanner.…”

Section: Methodsmentioning

confidence: 99%

Normative Femoral and Tibial Lengths in a Modern Population of Twenty-First-Century U.S. Children

Chen

Milbrandt

Babadi

et al. 2023

Journal of Bone and Joint Surgery

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Background:The Green-Anderson (GA) leg-length data remain the gold standard for the age-based assessment of leg lengths in children despite their methodologic weaknesses. We aimed to summarize current growth trends among a cross-sectional cohort of modern U.S. children using quantile regression methods and to compare the median femoral and tibial lengths of the modern U.S. children with those of the GA cohort.Methods:A retrospective review of scanograms and upright slot-scanning radiographs obtained in otherwise healthy children between 2008 and 2020 was completed. A search of a radiology registry revealed 3,508 unique patients between the ages of 2 and 18 years for whom a standard-of-care scanogram or slot-scanning radiograph had been made. All patients with systemic illness, genetic conditions, or generalized diseases that may affect height were excluded. Measurements from a single leg at a single time point per subject were included, and the latest available time point was used for children who had multiple scanograms made. Quantile regression analysis was used to fit the lengths of the tibia and femur and overall leg length separately for male patients and female patients.Results:Seven hundred patients (328 female and 372 male) met the inclusion criteria. On average, the reported 50th percentile tibial lengths from the GA study at each time point were shorter than the lengths in this study by 2.2 cm (range, 1.4 to 3.3 cm) for boys and 2 cm (range, 1.1 to 3.1 cm) for girls. The reported 50th percentile femoral lengths from the GA study at each time point were shorter than the lengths in this study by 1.8 cm (range, 1.1 to 2.5 cm) for boys and 1.7 cm (range, 0.8 to 2.3 cm) shorter for girls.Conclusions:This study developed new growth charts for femoral and tibial lengths in a modern U.S. population of children. The new femoral and tibial lengths at nearly all time points are 1 to 3 cm longer than traditional GA data. The use of GA data for epiphysiodesis could result in underestimation of expected childhood growth.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Scanography for Leg-Length Measurement: An Easy Satisfactory Method

Cited by 13 publications

References 0 publications

Risk factors for overgrowth after flexible intramedullary nailing for fractures of the femoral shaft in children

Risk factors for overgrowth after flexible intramedullary nailing for fractures of the femoral shaft in children

Reliability and Accuracy of MRI Scanogram in the Evaluation of Limb Length Discrepancy

Normative Femoral and Tibial Lengths in a Modern Population of Twenty-First-Century U.S. Children

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