The correct identification of Lichtman stage 3A and 3B Kienböck's disease is crucial for treatment purposes. The present study evaluates the reliability of the Lichtman classification, with specific attention to differentiating stage 3A and 3B.

Four reviewers evaluated wrist radiographs from 39 patients with Kienböck's disease. Radiographs were graded according to the traditional Lichtman classification, a modification of the Lichtman classification using a radioscaphoid angle of 60 degrees to subdivide stage 3, and 8 other radiographic measures.

The interobserver reliability of the Lichtman classification was substantial (kappa coefficient 0.63), but Stage 3A was less reliably identified (kappa 0.38). The new modification of the Lichtman classification increased both the overall (kappa 0.81) and the stage 3A (kappa 0.75) interobserver reliability.

The use of the radioscaphoid angle increases the interobserver reliability of the Lichtman classification. This should allow a better understanding of the clinically important distinction between stage 3A and 3B disease.

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