Systematic CT evaluation of reduction and hardware positioning of surgically treated calcaneal fractures: a reliability analysis

Abstract

IntroductionUp to date, there is a lack of reliable protocols that systematically evaluate the quality of reduction and hardware positioning of surgically treated calcaneal fractures. Based on international consensus, we previously introduced a 23-item scoring protocol evaluating the reduction and hardware positioning in these fractures based on postoperative computed tomography. The current study is a reliability analysis of the described scoring protocol.MethodsThree raters independently and systematically evaluated anonymized postoperative CT scans of 102 surgically treated calcaneal fractures. A selection of 25 patients was scored twice by all individual raters to calculate intra-rater reliability. The scoring protocol consisted of 23 items addressing quality of reduction and hardware positioning. Each of these four-option questions was answered as: ‘optimal’, ‘suboptimal (but not needing revision)’, ‘not acceptable (needing revision)’ or ‘not judgeable’. We used intraclass correlation coefficients (ICC’s) to calculate inter- and intra-rater reliability.ResultsInter-rater reliability of the overall 23-item protocol was good (ICC 0.66, 95% CI 0.64–0.69). Individual items that scored an inter-rater ICC ≥0.60 included evaluation of the calcaneocuboid joint, the posterior talocalcaneal joint, the anterior talocalcaneal joint, the position of the plate and sustentaculum screws and screws protruding the tuber and medial wall. The intra-rater reliability for the overall protocol was good for all three individual raters with ICC’s between 0.60 and 0.70.ConclusionOur scoring protocol for the radiological evaluation of operatively treated calcaneal fractures is reliable in terms of inter- and intra-rater reliability.

Intraoperative Effect of 2D vs 3D Fluoroscopy on Quality of Reduction and Patient-Related Outcome in Calcaneal Fracture Surgery

“…If the results of 3D fluoroscopy were made available to the surgeon, the surgeon was asked to evaluate the available 3D images according to a scoring protocol for anatomical reduction and implant position, which was published previously. 3 , 11 This protocol, based on Delphi consensus, specified 5 categories (23 individual points) to evaluate postoperative reduction of the most important anatomical landmarks of the calcaneus as well as hardware positioning. Corrections were performed (if deemed necessary and feasible) and registered accordingly, after which an additional 3D fluoroscopy scan was performed and evaluated in a similar fashion.…”

“…For evaluation of the quality of fracture reduction and fixation and whether a revision was indicated, the previously mentioned imaging 23-question scoring protocol was used. 3 , 11 Intra-articular gaps and steps measuring up to 2 mm were deemed acceptable. 11 A revision was indicated when one of the items was scored as “not acceptable.” An indication for a revision was based only on the radiological evaluation.…”

“… 3 , 11 Intra-articular gaps and steps measuring up to 2 mm were deemed acceptable. 11 A revision was indicated when one of the items was scored as “not acceptable.” An indication for a revision was based only on the radiological evaluation. Technical difficulties, duration of the operation, or other reasons not to perform a revision were not taken into account in the evaluation by the independent observers.…”