ArticlePediatric radiology2026
The gorilla lip sign: diagnostic utility of anteroposterior radiographs for pediatric talocalcaneal coalition.
Article in Pediatric radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
backgroundTalocalcaneal coalition is highly prevalent but diagnostically challenging due to the subtalar joint's complex anatomy, leading to frequent oversights on conventional radiographs. Existing signs rely primarily on lateral views, with variable sensitivity.
objectiveTo introduce and validate the "gorilla lip" sign on non-weight-bearing anteroposterior (AP) radiographs as a complementary diagnostic marker for talocalcaneal coalition. MATERIALS AND
methodsIn this retrospective study, non-weight-bearing AP ankle radiographs of 30 talocalcaneal coalition-confirmed feet (positive group) and 33 normal feet (negative group) from children aged ≤17 years were analyzed. The "gorilla lip" sign was defined by sustentaculum tali abnormalities: (1) osseous protuberance ≥50% medial malleolus height, (2) narrowed and rough articular surface, or (3) absent joint space. Three blinded observers independently assessed randomized images twice (2-month interval). Sensitivity, specificity, likelihood ratios, and inter-/intraobserver reliability were calculated.
resultsAcross two evaluations by three observers, sensitivity ranged from 77-93%, and specificity ranged from 85-100%. Positive likelihood ratios were ranging from 5.28 to infinite, indicating a high probability of talocalcaneal coalition when the sign is present, while low negative likelihood ratios (ranging from 0.07 to 0.24) suggest its absence is a strong indicator to rule out talocalcaneal coalition. The sign showed good interobserver reliability (Fleiss kappa, 0.65-0.70) and good to excellent intraobserver reliability (kappa, 0.67-0.87).
conclusionsThe "gorilla lip" sign is a highly sensitive, specific, and reproducible radiographic marker for diagnosing talocalcaneal coalition on non-weight-bearing AP ankle radiographs. Its application can complement traditional lateral view signs, enhancing diagnostic confidence and potentially reducing unnecessary examinations prompted by misdiagnosis.
Indexed as
Identifiers
41117936What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.