Interobserver Reliability and Intraobserver Reproducibility of Three Radiological Classification Systems for Intra-articular Calcaneal Fractures

Sayed-Noor, Arkan S.; Ågren, Per-Henrik; Wretenberg, Per

doi:10.3113/fai.2011.0861

Cited by 37 publications

(31 citation statements)

References 46 publications

(57 reference statements)

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“…In patients in whom a secondary arthrodesis was deemed necessary, BA was measured prior to this procedure. All measurements were rounded to a full degree because of interobserver measurement reliability [20,26,29] and were made by an independent observer. A specialised trauma surgeon verified all measurements.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Predicting loss of height in surgically treated displaced intra-articular fractures of the calcaneus

Backes

Dorr

Luitse

et al. 2015

International Orthopaedics (SICOT)

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Purpose The goal of calcaneal fracture surgery is to restore its anatomy and good foot function. However, loss of height of the subtalar joint can occur post-operatively, as expressed by a decrease in Böhler's angle (BA). The aim of this study was to identify potential factors associated with a post-operative decrease in BA. Methods All consecutive adult patients treated with open reduction and internal fixation (ORIF) by an extended lateral approach (ELA) between 2000 and 2013 were retrospectively included. Primary outcome was the occurrence of a calcaneal collapse, defined as a postoperative decrease of ≥10°in BA. The BA was measured pre-operatively, directly following surgery and at one year follow-up. Patient characteristics (body mass index, diabetes mellitus, smoking/alcohol/substance abuse, American Society of Anaesthesiologist classification), fracture classification and treatment characteristics: peroperative increase in BA and occurrence of post-operative wound infection (POWI) were collected. Results A total of 262 patients with 276 calcaneal fractures were included. A calcaneal collapse occurred in 46 cases (17 %). The median preoperative BA, per-operative increase in BA and post-operative decrease in BA were, respectively, 2°, 27°and 4°. A calcaneal collapse was seen more often following a per-operative increase of >25°in BA, but no significant association was found (p=0.056). Uni-and multivariate analysis showed that patients with substance abuse and those with POWI had significantly more calcaneal collapse (p<0.05). No association was found between substance abuse and the occurrence of POWI (p=0.293). Conclusions In nearly one in six patients with an intraarticular calcaneal fracture treated with ORIF by an ELA, a post-operative collapse of ≥10°was found during follow-up. Calcaneal collapse was correlated with the occurrence of a POWI and substance abuse.

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Section: Radiographic Evaluationmentioning

confidence: 99%

Predicting loss of height in surgically treated displaced intra-articular fractures of the calcaneus

Backes

Dorr

Luitse

et al. 2015

International Orthopaedics (SICOT)

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“…Intraarticular calcaneus fractures comprise 75% of all the calcaneus fractures. [3,4] Another important point to note is that the forces that cause the calcaneus fracture also injure the surrounding tissues to some extent.…”

mentioning

confidence: 99%

Mid-term results of Calcaneal Plating for Displaced Intraarticular Calcaneus Fractures

Gülabi¹,

Sari²,

Şen³

et al. 2013

Ulus Travma Acil Cerrahi Derg

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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

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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Interobserver Reliability and Intraobserver Reproducibility of Three Radiological Classification Systems for Intra-articular Calcaneal Fractures

Abstract: Clinicians should be aware of the limitation regarding the interobserver reliability and intraobserver reproducibility of the Letournel, Sanders and Zwipp classification systems for calcaneal fractures. Future studies should attempt to improve the present classification systems.

Cited by 37 publications

References 46 publications

Predicting loss of height in surgically treated displaced intra-articular fractures of the calcaneus

Predicting loss of height in surgically treated displaced intra-articular fractures of the calcaneus

Mid-term results of Calcaneal Plating for Displaced Intraarticular Calcaneus Fractures

Intra and interobserver analysis of the Sanders classification for calcaneal fractures

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