SICOT-J
Single-leg versus double-leg weight-bearing radiographs for coronal alignment assessment in patients with lower extremity trauma
By Pabla N, Noronha K, Siddapureddy S and 6 others.
Abstract
Introduction
Accurate assessment of coronal lower extremity alignment is critical for surgical planning and postoperative evaluation following orthopedic trauma. Although double-leg (DL) standing radiographs remain the standard for alignment assessment, single-leg (SL) stance more closely approximates physiologic loading during gait. Prior studies have demonstrated differences between DL and SL alignment measurements in patients with osteoarthritis and elective deformity correction, but comparable data in orthopedic trauma patients are lacking.
Methods
We performed a retrospective study of patients presenting to a Level I trauma center after lower extremity orthopedic surgery who underwent DL and SL standing radiographs during the same clinic visit. Lateral distal femoral angle, medial proximal tibial angle, and joint line convergence angle were measured by two blinded evaluators and averaged. The primary outcome was the proportion of limbs with at least one SL-DL difference exceeding the prespecified threshold (>3° for LDFA or MPTA; >2° for JLCA). Bland-Altman analyses assessed agreement, with patient-cluster bootstrap confidence intervals accounting for patients who contributed multiple limb encounters.