Pick a classification on the left and it opens on the right. This page holds the paediatric elective classifications. Turn on Test me to hide each answer until you tap Show answer, or press Random for a quick quiz. Each entry links to the page it comes from.
SUFE by timing
| Type | Presentation | Examination |
|---|---|---|
| Pre-slip | Lower limb weakness, limp and exertional groin, hip or knee pain. AP pelvis and frog leg lateral may show disuse osteopenia | Reduced internal rotation and guarding |
| Acute (10 to 15%) | Under 3 weeks, usually too painful to weight bear. Most have 1 to 3 months of prodromal knee, hip or thigh pain or limp | External rotation deformity, shortening and painful restricted motion |
| Chronic (about 85%) | Groin or thigh pain with a limp, with exacerbations and remissions over months to years | Antalgic gait, loss of internal rotation, abduction and flexion |
| Acute on chronic | Acute worsening of a chronic slip | As for an acute slip |
Loder (SUFE stability)
| Type | Definition | Osteonecrosis |
|---|---|---|
| Stable | Can weight bear, with or without crutches | Almost 0% |
| Unstable | Unable to weight bear, pain limits any attempt to move the limb | Up to 50% |
Original publication Loder RT, Richards BS, Shapiro PS, Reznick LR, Aronson DD. Acute slipped capital femoral epiphysis: the importance of physeal stability. J Bone Joint Surg Am. 1993;75(8):1134-40.
Herring lateral pillar (Perthes)
| Group | Description |
|---|---|
| A | Lateral pillar height fully preserved |
| B | Over 50% of lateral pillar height preserved |
| B/C border | Narrow or poorly ossified pillar near 50% |
| C | Under 50% of lateral pillar height preserved |
Original publication Herring JA, Neustadt JB, Williams JJ, Early JS, Browne RH. The lateral pillar classification of Legg-Calvé-Perthes disease. J Pediatr Orthop. 1992;12(2):143-50.
Stulberg (Perthes outcome)
| Class | Description |
|---|---|
| I and II | Spherical head, low arthritis risk |
| III and IV | Ovoid or flat congruent head |
| V | Flat head with incongruent joint, highest arthritis risk |
Original publication Stulberg SD, Cooperman DR, Wallensten R. The natural history of Legg-Calvé-Perthes disease. J Bone Joint Surg Am. 1981;63(7):1095-108.
Kocher criteria (septic hip)
| Criterion | Threshold |
|---|---|
| Non weight bearing | |
| Temperature | Over 38.5 degrees |
| ESR | Over 40 mm/h |
| WCC | Over 12 x 10^9/L |
| CRP (Caird) | Over 20 mg/L adds predictive value |
Langenskiold (Blount disease)
| Stage | Radiographic features |
|---|---|
| I | Irregular medial metaphyseal ossification with beaking |
| II | Saucer shaped depression of the medial metaphysis with a step |
| III | Deeper step with the medial epiphysis sloping into the defect |
| IV | Medial epiphysis fills the metaphyseal depression |
| V | Cleft dividing the medial epiphysis (double epiphysis) with articular depression |
| VI | Bony bar across the medial physis |
Original publication Langenskiöld A. Tibia vara; (osteochondrosis deformans tibiae); a survey of 23 cases. Acta Chir Scand. 1952;103(1):1-22.
Saupe (bipartite patella)
| Type | Location |
|---|---|
| I | Inferior pole |
| II | Lateral margin |
| III | Superolateral pole, the most common |
Staheli rotational profile
| Measure | Normal |
|---|---|
| Foot progression angle | 5° ± 10° |
| Thigh foot angle | 15° ± 15° |
| Hip internal and external rotation | 45° ± 15° each |
| Transmalleolar axis | 0 to 30° external rotation |
Original publication Staheli LT, Corbett M, Wyss C, King H. Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am. 1985;67(1):39-47.
Congenital lower limb deficiency
| Deficiency | Classification | Features |
|---|---|---|
| Fibular hemimelia | Achterman and Kalamchi | Most common long bone deficiency. Short tibia, anteromedial bowing, ball and socket ankle, tarsal coalition, absent lateral rays, ACL deficiency, genu valgum |
| Congenital femoral deficiency (PFFD) | Aitken, Paley | Short femur, coxa vara, hip instability, knee cruciate deficiency. Often associated with fibular hemimelia |
| Tibial hemimelia | Jones | Rare. Absent or deficient tibia with a prominent fibula |
Aitken (PFFD)
| Type | Description |
|---|---|
| A | Radiographic defect in the upper femur that later ossifies, femoral head & acetabulum form, varus deformity & shaft may be higher than the head |
| B | Tuft at proximal end of femur, never get connection between head & shaft (pseudoarthrosis), acetabulum & head are present, femur short |
| C | Absent femoral head, flat-absent acetabulum, short femur |
| D | As in C but with very short femur represented by femoral condyles |
Tibial hemimelia
| Type | Description |
|---|---|
| 1 | Tibia not seen at birth |
| 1a | upper tibia not present |
| 1b | upper tibia is late to ossify |
| 2 | Proximal tibia ossified, distal tibia absent |
| 3 | Distal tibia is ossified, proximal tibia absent |
| 4 | Congenital Diastases of the ankle |
Congenital pseudarthrosis of the tibia
| Type | Description |
|---|---|
| 1 Non-dysplastic | ~Increased cortical density ~Dense medullary canal |
| 2 Dysplastic | |
| a | ~Wide medullary canal ~Failure of tubulation |
| b | ~Cystic lesion before fracture or canal enlargement from a previous fracture |
| c | ~Fracture, Cysts & Frank pseudarthrosis; Narrowed ends of fragments |
Clubfoot scoring (Pirani and Dimeglio)
| System | Description |
|---|---|
| Pirani score | Six clinical signs each scored 0, 0.5 or 1, total 0 to 6 |
| Dimeglio | Grades I to IV by reducibility, scored out of 20 |
Original publication Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F. Classification of clubfoot. J Pediatr Orthop B. 1995;4(2):129-36.
Coleman (vertical talus)
| Type | Description |
|---|---|
| 1 | Rigid dorsal dislocation of the talonavicular joint |
| 2 | Talonavicular dislocation with calcaneocuboid dislocation or subluxation |
Smillie (Freiberg disease)
| Stage | Features |
|---|---|
| I | Subchondral fissure fracture through the ischaemic epiphysis |
| II | Central bone resorption with early collapse of the articular surface |
| III | Further collapse with a central projection, plantar cartilage intact |
| IV | Fracture of the projection with loose body formation |
| V | Flattening and deformity of the head with arthrosis |
Coughlin (tailor bunionette)
| Type | Description |
|---|---|
| 1 | Enlarged fifth metatarsal head or lateral condyle |
| 2 | Lateral bowing of the fifth metatarsal shaft with a normal intermetatarsal angle |
| 3 | Increased fourth to fifth intermetatarsal angle, the most common |
Original publication Coughlin MJ. Treatment of bunionette deformity with longitudinal diaphyseal osteotomy with distal soft tissue repair. Foot Ankle. 1991;11(4):195-203.
Bayne and Klug (radial longitudinal deficiency)
| Type | Description |
|---|---|
| 0 | Normal radius with carpal or thumb anomaly |
| 1 | Short distal radius |
| 2 | Hypoplastic radius |
| 3 | Partial absence |
| 4 | Complete absence, the commonest |
Original publication Bayne LG, Klug MS. Long-term review of the surgical treatment of radial deficiencies. J Hand Surg Am. 1987;12(2):169-79.
Cleary and Omer (radioulnar synostosis)
| Type | Description |
|---|---|
| 1 | Fibrous synostosis with a normal, reduced radial head |
| 2 | Osseous synostosis with a normal, reduced radial head |
| 3 | Osseous synostosis with a hypoplastic, posteriorly dislocated radial head |
| 4 | Short osseous synostosis with an anteriorly dislocated, mushroom shaped radial head |
Original publication Cleary JE, Omer GE Jr. Congenital proximal radio-ulnar synostosis. Natural history and functional assessment. J Bone Joint Surg Am. 1985;67(4):539-45.
Brachial plexus birth palsy
| Type | Roots | Features | Frequency |
|---|---|---|---|
| Upper (Erb-Duchenne) | C5, C6 | Weak deltoid, external rotators, biceps, brachialis, brachioradialis and supinator. Waiter’s tip posture with the shoulder adducted and internally rotated, forearm pronated and wrist flexed. Minimal sensory loss, later elbow flexion contracture | Commonest |
| Complete | C5 to T1 | Flaccid paralysis of the whole limb, with or without vasomotor changes giving a marbled hand | Second most common |
| Lower (Klumpke) | C8, T1 | Weak wrist and long finger flexors and intrinsics. Poor hand function with good shoulder and elbow function | Least common |
Minami (capitellar OCD)
| Grade | Description |
|---|---|
| I | Translucent shadow in mid capitellum |
| II | Clear zone between lesion and adjacent bone |
| III | Loose body |
Fielding and Hawkins (atlantoaxial rotatory)
| Type | Description |
|---|---|
| I | Rotatory fixation, no anterior displacement, ligament intact, most common |
| II | Anterior displacement 3 to 5 mm, one lateral mass acting as pivot |
| III | Anterior displacement more than 5 mm |
| IV | Posterior displacement |
Original publication Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am. 1977;59(1):37-44.
Os odontoideum
| Type | Description |
|---|---|
| Orthotopic | Ossicle moves with the anterior arch of C1 |
| Dystopic | Ossicle fused to the clivus or displaced |
Congenital kyphosis
| Type | Description |
|---|---|
| I | anterior failure of vertebral body formation |
| II | failure of segmentation |
| III | mixed |
| IV | unclassifiable because of its complexity |
GMFCS (cerebral palsy)
| Level | Description |
|---|---|
| 1 | Speed / balance and coordination are impaired, but patient is able to walk, play and climb stairs without need for railings |
| 2 | Speed, balance, coordination are all significantly impaired, patients may use gait aids (hand-held or wheelchair) depending on terrain and distance, will use railings for stairs and will have very limited running and jumping |
| 3 | Patients will utilise hand-held gait aids for most indoor movement, with wheeled mobility for outdoors and long distances, may self-propel for shorter distances. |
| 4 | Children use methods of mobility that require physical assistance or powered mobility in most settings. They may walk for short distances at home with physical assistance or use powered mobility or a body support walker when positioned. Outdoors / community mobility is in a manual wheelchair or powered mobility. |
| 5 | Totally dependent on assistance, wheelchair bound in all settings, limited ability to maintain antigravity head and trunk postures or control leg and arm movements |
Hoffer (spina bifida ambulation)
| Category | Description |
|---|---|
| Community ambulator | Walks indoors and outdoors with or without orthoses, wheelchair only for long trips or speed |
| Household ambulator | Walks only indoors with orthoses, independent or minimally assisted transfers, wheelchair outdoors |
| Non-functional ambulator | Walks only as therapy, wheelchair for mobility |
| Non-ambulator | Wheelchair bound, often able to transfer from bed to chair |
Original publication Hoffer MM, Feiwell E, Perry R, Perry J, Bonnett C. Functional ambulation in patients with myelomeningocele. J Bone Joint Surg Am. 1973;55(1):137-48.
Spina bifida neurosegmental level
| Level | Functioning muscles | Mobility |
|---|---|---|
| Thoracic | No voluntary lower limb function | Wheelchair |
| High lumbar (L1 to L3) | Hip flexors, with or without hip adductors and knee extensors | Children use HKAFO or KAFO, 75% of adolescents and adults use a wheelchair |
| Low lumbar (L4, L5) | As above plus knee extensors and flexors and ankle dorsiflexors, with or without hip abductors | 75% of adults are community ambulators, most with an AFO |
| Sacral (S1 to S4) | As above plus ankle plantarflexors, with or without toe flexors | Community ambulators for limited distances, with or without shoe orthoses |
Siffert (osteochondroses)
| Type | Description | Examples |
|---|---|---|
| Articular | Joint surface and epiphysis, with risk of secondary osteoarthritis | Perthes, Freiberg, Kohler, Panner |
| Non-articular | Traction apophysitis at a tendon or ligament insertion, self-limiting | Osgood-Schlatter, Sever, Sinding-Larsen-Johansson |
| Physeal | Growth plate involvement with resulting deformity | Blount, Scheuermann |
Original publication Siffert RS. Classification of the osteochondroses. Clin Orthop Relat Res. 1981;(158):10-8.
Neurofibromatosis
| Type | Features |
|---|---|
| NF 1 | 2 or more of the National Institute of Health criteria At least 6 café au lait spots (> 5mm in children, > 15 mm in adults) 2 neurofibromas or 1 plexiform neurofibroma Freckling of the inguinal or axillary region Optical glioma At least 2 Lisch nodules (iris condensations / hamartoma of the iris) A first degree relative with NF A distinctive osseous lesion (sphenoid dysplasia, thinning of long bone cortex with or without pseudarthrosis) |
| NF 2 | Bilateral acoustic neuromas (bilateral vestibular schwannomas). Paucity of peripheral findings |
Muscular dystrophy
| Inheritance | Types |
|---|---|
| X linked | Duchenne, Becker, Emery-Dreifuss |
| Autosomal recessive | Limb girdle, infantile facioscapulohumeral |
| Autosomal dominant | Facioscapulohumeral, distal, ocular, oculopharyngeal |
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More paediatric classifications
Alphabetical
- Developmental Dysplasia of the Hip
Classification of Developmental Dysplasia of the Hip (DDH)
1. By "Type"
- Identified in perinatal period & respond well
- Secondary to neuromuscular disorder
- Teratologic disorders
2. by "Degree"
- Hip instability
- Hip subluxable
- Hip dislocatable
- Hip dislocated
3. Radiological
- Epiphysis medial to Perkins & below Hilgenreiner's
- Below Hilgenreiner's but lateral to Perkins
- Lateral to Perkins at level of acetabular margin
- Lateral to Perkins & above acetabulum
4. Also "Early" or "Late"
- Osteochondritis Dissecans of the Talus
Orthopaedic Classifications
Classification of Osteochondritis Dissecans (OCD) of the Talus
| Grading | Description |
|---|---|
| I | undisplaced |
| II | partially detached |
| III | detached but not displaced |
| IV | detached + displaced or rotated |
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.