Reproducibility and agreement of radiographic assessment of carpal deformities in foals

Alexandre Charles, Xavier Peeters, Constance Verbrugghe, et al.

Background:
Carpal deformities in foals are common orthopedic conditions that may require early intervention. The study evaluates the intra- and interobserver reproducibility of the Pivot Point (PP) method and subjective evaluation for identifying and measuring carpal deviation. It also compares the agreement between these two techniques.

Methods:
The retrospective study analyzed 52 dorsopalmar radiographs from 25 foals under 6 months old. Six observers with varying experience levels (radiologists, surgeons, and students) independently evaluated the radiographs twice, two weeks apart. Observers assessed:

1. Subjective origin of deviation (Orig_dev).
2. PP method measurements (PP_Angle).

Statistical analyses, including correlation coefficients and Cramer tests, evaluated intra- and interobserver reproducibility, as well as agreement between methods.

Results:
-Intraobserver reproducibility:

-High for PP_Angle (correlation coefficient: 0.93, p < 0.05).
-Good agreement between PP and subjective Orig_dev (Cramer coefficient: 0.41, p < 0.05).

-Interobserver reproducibility:

-Poor agreement (Kappa values: 0.20–0.26, p < 0.05).
-Highest variability occurred in cases with lateral bowing of the distal radius.

-Radiologists exhibited higher consistency than surgeons or students.

-Agreement between PP and subjective Orig_dev was strong within the same observer.

Limitations:
-Interobserver reproducibility was low, likely due to variability in applying the PP method without standardized guidelines.
-Radiograph quality and positioning were subjectively graded, which could introduce bias.
-Retrospective nature excluded clinical context, which might affect decision-making in real practice.

Conclusions:
The PP method is reliable for repeated measurements by the same reader but less consistent across different readers. When only the origin of deviation is required, subjective evaluation may suffice without the PP method. For critical decisions like surgery, multiple assessments by different observers are recommended to minimize error.

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