Interobserver Reliability of Pirani and Dimeglio Scores in the Clinical Evaluation of Idiopathic Congenital Clubfoot

Background: Dimeglio (DimS) and Pirani (PirS) scores are the most common scores used in congenital talipes equinovarus (CTEV) clinical practice. The aim of this study was to evaluate the interobserver reliability of these scores and how clinical practice can influence the clinical outcome of clubfoot through the DimS and Pirs. Methods: Fifty-four feet were assessed by six trained independent observers through the DimS and PirS: three consultants (OS), and three residents (RS) divided into three pediatric orthopaedic surgeons (PeO) and three non-pediatric orthopaedic surgeons (NPeO). Results: The PirS and DimS Scores were strongly correlated. In the same way, OS and RS, PirS, and DimS scores were strongly correlated, and the interobserver reliability ranked “good” in the comparison between PeO and NPeO. In fully trained paediatric orthopaedic surgeons, an “excellent” interobserver reliability was found but was only “good” in the NPeO cohort. Conclusions: In conclusion, after careful preparation, at least six months of observation of children with CTEV, PirS and DimS proved to be valid in terms of clinical evaluation. However, more experience with CTEV leads to a better clinical evaluation.

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Ponseti Treatment in the Management of Clubfoot Deformity – A Continuing Role for Paediatric Orthopaedic Services in Secondary Care Centres

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x187739 ◽

2007 ◽

Vol 89 (5) ◽

pp. 510-512 ◽

Cited By ~ 14

Author(s):

Charles EJ Docker ◽

Simon Lewthwaite ◽

Nigel T Kiely

Keyword(s):

Tertiary Care ◽

Resource Utilisation ◽

Tertiary Referral Centre ◽

Congenital Talipes Equinovarus ◽

Hub And Spoke ◽

Surgical Interventions ◽

Achilles Tenotomy ◽

Talipes Equinovarus ◽

Paediatric Orthopaedic ◽

Set Up

INTRODUCTION The Ponseti technique is a well-proven way of managing paediatric clubfoot deformity. We describe a management set-up which spreads the care between secondary and tertiary care with no loss of quality. PATIENTS AND METHODS In our audit of the first 2 years of Ponseti casting in the treatment of idiopathic congenital talipes equinovarus (CTEV, clubfoot) deformity, we identified 77 feet having been treated in 50 patients. Forty-nine feet were treated primarily in Oswestry, a tertiary referral centre for paediatric orthopaedic conditions, and 13 feet were treated in conjunction with the physiotherapy department at one of the region's district general hospitals (Leighton Hospital, Crewe, Cheshire). RESULTS Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found in both cohorts. CONCLUSIONS This ‘hub-and-spoke’ approach would appear to be efficient in terms of resource utilisation. Additional benefits atients and their carers include ease of access to services and reduced financial and transport burdens.

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The reliability of the AOSpine Thoracolumbar Spine Injury Classification System in children: an international validation study

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.15.200188 ◽

2021 ◽

pp. 1-7

Author(s):

Andrew Z. Mo ◽

Patricia E. Miller ◽

Javier Pizones ◽

Ilkka Helenius ◽

Michael Ruf ◽

...

Keyword(s):

Classification System ◽

Interobserver Reliability ◽

Thoracolumbar Spine ◽

Paediatric Population ◽

Spine Injury ◽

Level Of Evidence ◽

Orthopaedic Surgeons ◽

Intraobserver Reproducibility ◽

Paediatric Orthopaedic ◽

Injury Classification

Purpose To evaluate the AOSpine Thoracolumbar Spine Injury Classification System and if it is reliable and reproducible when applied to the paediatric population globally. Methods A total of 12 paediatric orthopaedic surgeons were asked to review MRI and CT imaging of 25 paediatric patients with thoracolumbar spine traumatic injuries, in order to determine the classification of the lesions observed. The evaluators classified injuries into primary categories: A, B and C. Interobserver reliability was assessed for the initial reading by Fleiss’s kappa coefficient (kF) along with 95% confidence intervals (CI). For A and B type injuries, sub-classification was conducted including A0-A4 and B1-B2 subtypes. Interobserver reliability across subclasses was assessed using Krippendorff’s alpha (αk) along with bootstrapped 95% CIs. A second round of classification was performed one-month later. Intraobserver reproducibility was assessed for the primary classifications using Fleiss’s kappa and sub-classification reproducibility was assessed by Krippendorff’s alpha (αk) along with 95% CIs. Results In total, 25 cases were read for a total of 300 initial and 300 repeated evaluations. Adjusted interobserver reliability was almost perfect (kF = 0.74; 95% CI 0.71 to 0.78) across all observers. Sub-classification reliability was substantial (αk= 0.67; 95% CI 0.51 to 0.81), Adjusted intraobserver reproducibility was almost perfect (kF = 0.91; 95% CI 0.83 to 0.99) for both primary classifications and for sub-classifications (αk = 0.88; 95% CI 0.83 to 0.93). Conclusion The inter- and intraobserver reliability for the AOSpine Thoracolumbar Spine Injury Classification System was high amongst paediatric orthopaedic surgeons. The AOSpine Thoracolumbar Spine Injury Classification System is a promising option as a uniform fracture classification in children. Level of Evidence III

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A Clinical Evaluation of Operative Procedures for Congenital Talipes Equinovarus

The Journal of Bone and Joint Surgery (American) ◽

10.2106/00004623-195739020-00003 ◽

1957 ◽

Vol 39 (2) ◽

pp. 265-420 ◽

Cited By ~ 2

Author(s):

RAYMOND F. KUHLMANN ◽

JOHN F. BELL

Keyword(s):

Clinical Evaluation ◽

Operative Procedures ◽

Congenital Talipes Equinovarus ◽

Talipes Equinovarus ◽

Congenital Talipes

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Correlation of Foot Bimalleolar Angle with Pirani Scoring System in Clinical Evaluation of Congenital Talipes Equinovarus

Journal of Foot and Ankle Surgery Asia Pacific ◽

10.5005/jp-journals-10040-1022 ◽

2015 ◽

Vol 2 (1) ◽

pp. 17-21

Author(s):

Abhay Shankar Dube ◽

Manvender Gaur ◽

Avinash Rastogi ◽

Rajat Kapoor

Keyword(s):

Clinical Evaluation ◽

Scoring System ◽

Clinical Severity ◽

Asia Pacific ◽

Congenital Talipes Equinovarus ◽

Pirani Score ◽

Talipes Equinovarus ◽

Reproducible Method ◽

Congenital Talipes ◽

Change In Mean

ABSTRACT The correlation of anteromedial foot bimalleolar angle with Pirani score evaluated prospectively in 120 children (204 feet) with congenital talipes equinovarus (CTEV). The patients were divided into groups I, II and III based on clinical severity before casting, having the Pirani score 0 to 2, 2.5 to 4 and 4.5 to 6 respectively. Mean foot bimalleolar angle 75.75°, 67.62° and 58.28° of groups I, II and III respectively was correlated by standard deviation with their Pirani scores to evaluate the severity difference among the groups before initiation of the casting treatment. The change in clinical severity or Pirani score was further correlated with the change in mean foot bimalleolar angle at the time of completion of casting and before bracing. The foot bimalleolar angle is an objective, quantitative and reproducible method which can be used to classify, prognosticate and to monitor the progress of the treatment. Background The prospective observational study on role of foot bimalleolar angle against the Pirani scoring in clinical evaluation of club foot in 120 children (204 feet) with mean age of 5.4 months treated by Ponseti technique of casting. How to cite this article Dube As, Gaur M, Rastogi A, Kapoor R. Correlation of Foot Bimalleolar Angle with Pirani Scoring System in Clinical Evaluation of Congenital Talipes Equinovarus. J Foot Ankle Surg (Asia-Pacific) 2015;2(1):17-21.

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Clubfoot: current concept of treatment

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-4-431-434 ◽

2021 ◽

Vol 27 (4) ◽

pp. 431-434

Author(s):

A. Andreacchio ◽

◽

F. Alberghina ◽

S. Monforte ◽

A. Dimeglio ◽

...

Keyword(s):

Current Knowledge ◽

Ponseti Method ◽

Idiopathic Clubfoot ◽

Invasive Treatment ◽

Congenital Talipes Equinovarus ◽

Treatment Techniques ◽

Talipes Equinovarus ◽

Limb Deformities ◽

Paediatric Orthopaedic

Introduction Idiopathic clubfoot (IC), also referred to as congenital talipes equinovarus, is one of the most common lower limb deformities observed in newborns, leading to significant functional impairment when left untreated. Early minimally invasive treatment has been praised as one of the most successful practice of modern pediatric orthopedics. This review aims to report current knowledge and controversies about clubfoot treatment. Material and methods We describe the main trends in clubfoot managing, identifying peculiarities, difficulties and prognostic factors related to the treatment. Results Many treatment techniques either conservative, surgical or hybrid have been used over the past decades. Based on good and excellent results during long-term follow-up, Ponseti method has been globally accepted by paediatric orthopaedic surgeons as standard method of treatment. However, some other conservative methods are still widely applied in the clinical setting, such as the French Physical Therapy method. Adherence to the bracing protocol is critical for the long-term success of the treatment, being a better predictor for relapse than severity of the deformity at birth. Conclusions Taking care of the manipulation and casting details by trained professionals, together with enhancing the child and patents’ adherence to the brace, are essential for the success of conservative treatment. Surgery should be performed only when strictly needed, preferably on a “a la carte” approach.

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