Are plain radiographs reliable in Lichtman classification?

Area of Science:

• Orthopedics
• Radiology
• Hand Surgery

Background:

• Kienböck's disease is a condition affecting the lunate bone in the wrist.
• Accurate classification is crucial for treatment planning and prognosis.
• The Lichtman classification is a widely used system for staging Kienböck's disease.

Purpose of the Study:

• To assess the inter-observer reliability of the Lichtman classification system.
• To compare the reliability across different levels of surgical expertise.

Main Methods:

• 30 orthopedic surgeons (residents, general orthopedic surgeons, hand surgeons) evaluated 40 wrist radiographs of Kienböck's disease patients.
• Observers classified the disease using the Lichtman system.
• Inter-observer agreement was measured using the kappa statistic.

Main Results:

• Overall agreement with the Lichtman classification was fair (kappa=0.203).
• Reliability was poor among residents (kappa=0.162).
• Fair reliability was observed among general orthopedic surgeons (kappa=0.210) and hand surgeons (kappa=0.252).

Conclusions:

• The Lichtman classification demonstrates limited reliability among orthopedic specialists.
• The system alone is insufficient for clinical decision-making.
• Supplementing with other imaging and measurement techniques is recommended for reliable assessment.