title: The ICI classification for calcaneal injuries: a validation study.
abstract: BACKGROUND
  The integral classification of injuries (ICI), by Zwipp et al. has been developed as a classification system for injuries of the bones, joints, cartilage and ligaments of the foot. It follows the principles of the comprehensive classification of fractures by Müller et al. The ICI was developed for 'everyday use' and scientific purposes. Our aim was to perform a validation study for this classification system applied to the calcaneal injuries.
  
  
  METHODS
  A panel of five experienced trauma and orthopaedic surgeons evaluated the ICI score in 20 calcaneal injuries. After 2 months, a second classification was performed in a different order. Inter- and intra-observer variability were evaluated by kappa statistics.
  
  
  RESULTS
  Panel members were not able to evaluate capsule and ligamental injuries based on X-ray and computed tomography (CT) films. Two injuries were excluded for logistical reasons. The inter-observer agreement based on 18 injuries of bone and joints was slight; kappa 0.14 (90% confidence interval (CI): 0.05-0.22). The intra-observer agreement was fair; kappa 0.31 (90% CI: 0.22-0.41). Overall, the panel rated the system as very complicated and not practical.
  
  
  CONCLUSIONS
  The ICI is a complicated classification system with slight to fair inter- and intra-observer variabilities. It might not be a practical classification system for calcaneal injuries in 'everyday use' or scientific purposes.
authors: Department of Surgery, Amphia Hospital, P.O. Box 90158, 4800 RK Breda, The Netherlands. hfrima@gmail.com
authors: Herman
authors: H
authors: Frima
authors: Rienk
authors: R
authors: Eshuis
authors: Paul
authors: P
authors: Mulder
authors: Luke
authors: L
authors: Leenen
mesh_terms: D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005528:Foot / Q000033:anatomy & histology; D050723:Fractures, Bone / Q000145:classification* / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed