Assessment of Reproducibility of Sanders Classification for Calcaneal Fractures

Piovesana, Lucas Gonzaga; Lopes, Hériston Cristovam; Pacca, Daniel Moreira; Ninomiya, André Felipe; Dinato, Mauro César Mattos e; Pagnano, Rodrigo Gonçalves

doi:10.1590/1413-785220162402154682

Cited by 7 publications

(5 citation statements)

References 13 publications

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“…Although most other studies have reviewed all types of displaced intraarticular calcaneal fractures (Sanders types II to IV) treated with plate osteosynthesis with or without autologous iliac bone grafting, we only investigated Sanders type III calcaneal fractures. Sanders type III calcaneal fractures consist of 3 articular pieces resulting from 2 fracture lines and are divided into 3 subtypes (IIIAB, IIIAC, and (IIIBC) according to whether the fracture line location is lateral (A), central (B), or medial (C) (6,7,47). In the present study, an excellent or good anatomic result was achieved in both groups as shown on both the radiographs (Fig.…”

Section: Discussionsupporting

confidence: 59%

“…important role in the evaluation of calcaneal fractures and aids surgeons by providing details that affect decisions on the final treatment (5). The Sanders classification system is based on the CT scan findings and is the most commonly used system for describing intraarticular fractures of the calcaneus (6,7). It consists of 4 types determined by the fracture line location at the posterior facet.…”

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confidence: 99%

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Short-Term Outcomes of Open Reduction and Internal Fixation for Sanders Type III Calcaneal Fractures With and Without Bone Grafts

Cao

et al. 2018

The Journal of Foot and Ankle Surgery

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Calcaneal fractures, often caused by a fall from a height, are the most common injuries encountered by orthopedic surgeons. Currently, open anatomic reduction and internal fixation (ORIF) is considered a valuable treatment of displaced intraarticular fractures of the calcaneus; however, the need for bone grafting in the treatment is still controversial. Therefore, in the present study, we investigated the outcomes of 2 methods (with and without bone grafting) used for the surgical treatment of Sanders type III calcaneal fractures. From January 2013 to September 2015, 57 cases (55 patients) with displaced Sanders type III calcaneal fractures (53 unilateral and 2 bilateral) were enrolled. The patients were divided into 2 groups: group I was treated by ORIF with bone grafting (n = 28) and group II was treated by ORIF without bone grafting (n = 29). The radiologic evaluation included Böhler's angle, Gissane's angle, and the height and width of the calcaneum. In addition, the American Orthopaedic Foot and Ankle Society questionnaires and visual analog scale were completed by the patients. During the follow-up period, no differences were found in the outcome measures (Böhler's angle, p = .447; Gissane's angle, p = .599; calcaneal height, p = .065; calcaneal width p = .077; and American Orthopaedic Foot and Ankle Society questionnaires, p = .282) with or without bone grafting. The only difference between the 2 groups was the occurrence of postoperative pain (p = .024 and p = ≤ .05), which was greater in the patients who had undergone bone grafting. We have provided evidence that bone grafting with internal fixation in the treatment of intraarticular calcaneal fractures failed to improve the restoration of Böhler's angle or Gissane's angle. No statistically significant difference was found in the short-term outcomes between the 2 methods used for the surgical treatment of Sanders type III calcaneal fractures.

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Section: Discussionsupporting

confidence: 59%

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confidence: 99%

Short-Term Outcomes of Open Reduction and Internal Fixation for Sanders Type III Calcaneal Fractures With and Without Bone Grafts

Cao

et al. 2018

The Journal of Foot and Ankle Surgery

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“…Das 12 fraturas analisadas, havia 8 homens (9 fraturas) e 3 mulheres, sendo 5 do lado esquerdo, 7 do direito e média de idade de 44,5 anos (31 a 59). A tabela 5 representa a avaliação da reprodutibilidade e a concordância obtida estratificando por tempo de experiência e por nível de atuação (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) . Com base nos dados, observa-se que os cirurgiões menos experientes, tanto do ponto de vista de tempo de atuação quanto de porcentagem de atuação, tiveram concordância intraobservador estatisticamente superior ao grupo dos mais experientes.…”

Section: Resultsunclassified

“…Esse autor, assim como Brunner, encontrou uma concordância significativamente maior entre os mais experientes (14,25) . Lauder não encontrou diferença quanto à experiência dos examinadores e, por outro lado, Piovesana, assim como nosso estudo, encontrou melhor reprodutibilidade intraobservador entre examinadores menos experientes (12,17) .…”

Section: Resultsunclassified

Intra and interobserver analysis of the Sanders classification for calcaneal fractures

et al. 2019

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Objective: To evaluate the intra and interobserver variation in the Sanders classification of calcaneal fractures and the clinical-radiological correlation of postoperative X-ray images and computed tomography (CT) scans. Methods: We sent pre- and postoperative images in the form of a questionnaire to 18 foot and ankle surgeons with varying experience and examined evaluations of the postoperative reduction and Sanders classification quality criteria of 12 calcaneal fractures. The kappa (Ƙ) values were calculated and compared to those in the literature, and the quality of the reduction was compared to the patient's American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) score. Results: The mean intraobserver Ƙ of the Sanders classification was 0.49. Disregarding the subclasses, the intraobserver Ƙ was 0.55, and when type III and IV fractures were grouped, the intraobserver Ƙ was 0.57. The interobserver Ƙ values in these same three conditions were 0.22, 0.20, and 0.21, respectively. We also observed that the group of less experienced surgeons showed better intraobserver Ƙ values than the more experienced surgeons. In the analysis of the reduction quality based on X-ray images and the AOFAS-AHS score of the patient, we found a value of p=0.043. Conclusion: The Ƙ values were consistent with previous studies, confirming moderate intraobserver reproducibility and acceptable interobserver reliability. We also confirmed the presence of a significant relationship between the reduction quality based on X-ray images and the AOFAS-AHS score of the patient. Level of Evidence III; Diagnostic Studies; Nonconsecutive patients, no uniformly applied reference gold standard.

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“…The Sanders classification system is the most commonly used system for categorizing intraarticular fractures. [ 10 , 11 ] This case is type IIIAB according to Sanders classification system. It has never been reported in the literatures about Sanders type IIIAB calcaneal fractures without broken lateral wall.…”

Section: Discussionmentioning

confidence: 99%

Sanders type IIIAB calcaneal fracture without broken lateral wall

Zou¹,

Tang²,

Hu³

et al. 2018

Medicine

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Rationale:The calcaneal fracture without broken lateral wall is rare and the open anatomic reduction and internal fixation (ORIF) is necessary when the subtalar joint articular surface is broken and collapsed.Patient concerns:A 45-year-old male was admitted to our department with complaints of heel pain and swelling after falling down from 1-m-high stone. He was unable to bear weight on his right foot.Diagnoses:Imaging studies confirmed that it was a sanders type IIIAB calcaneal fracture without broken lateral wall and the middle part of the posterior calcaneal articular facet collapsed.Interventions:ORIF of intraarticular calcaneal fracture with the locking calcaneal plate was performed.Outcomes:The patient recovered completely after 16 weeks and was able to participate in his usual work.Lessons:Based on this case and literature we reviewed, computed tomography scan (CT scan) should be used to diagnose and evaluate the severity of calcaneal fractures. Currently, ORIF was the preferred surgical treatment option when dealing with displaced intraarticular calcaneal fractures.

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Assessment of Reproducibility of Sanders Classification for Calcaneal Fractures

Cited by 7 publications

References 13 publications

Short-Term Outcomes of Open Reduction and Internal Fixation for Sanders Type III Calcaneal Fractures With and Without Bone Grafts

Short-Term Outcomes of Open Reduction and Internal Fixation for Sanders Type III Calcaneal Fractures With and Without Bone Grafts

Intra and interobserver analysis of the Sanders classification for calcaneal fractures

Sanders type IIIAB calcaneal fracture without broken lateral wall

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