title: Evaluation of reduction and fixation of calcaneal fractures: a Delphi consensus.
abstract: BACKGROUND
  Postoperative radiological assessment of the quality of reduction and fixation of calcaneal fractures is essential when evaluating treatment success. However, a universally accepted radiological evaluation protocol is currently unavailable. The aim of this study was to obtain an expert-based consensus on the most important criteria for the radiological assessment of the quality of reduction and fixation of calcaneal fractures.
  
  
  METHODS
  The Delphi method, consisting of three rounds, was used to obtain consensus. Each round focused on four main topics of calcaneal fracture evaluation: imaging technique (38 items), anatomical landmarks (21 items), fracture reduction (16 items) and position of the fixation material (9 items). We invited ten radiologists and 44 surgeons from the USA and Europe (all calcaneus experts) to complete online questionnaires. They were asked which aspects require evaluation to determine the quality of fracture reduction and fixation. Agreement was expressed as the percentage of respondents with identical answers. Consensus was defined as an agreement of at least 80 %.
  
  
  RESULTS
  All experts were invited for the three Delphi rounds and 16, 18, and 15 specialists responded per round, respectively. Agreement was reached for 23/38 (60 %) items regarding imaging techniques, 20/21 (95 %) anatomical landmarks, 13/16 (81 %) items regarding fracture reduction and 8/9 items (89 %) regarding fracture fixation.
  
  
  CONCLUSIONS
  This Delphi consensus shows that more aspects require evaluation than currently used in radiological evaluation protocols. With this consensus, we provide the basis for a universal evaluation protocol to assess the radiological outcome of calcaneal fracture treatment.
authors.affiliation: Trauma Unit, Department of Surgery, Academic Medical Center, P. O. Box 22660, 1100 DD, Amsterdam, The Netherlands, m.s.beerekamp@amc.nl.
authors.forename: M S H
authors.initials: MS
authors.lastname: Beerekamp
authors.forename: J S K
authors.initials: JS
authors.lastname: Luitse
authors.forename: D T
authors.initials: DT
authors.lastname: Ubbink
authors.forename: M
authors.initials: M
authors.lastname: Maas
authors.forename: N W L
authors.initials: NW
authors.lastname: Schep
authors.forename: J C
authors.initials: JC
authors.lastname: Goslings
mesh_terms: D059925:Anatomic Landmarks; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D003131:Combined Modality Therapy; D003697:Delphi Technique; D005060:Europe; D005592:Fracture Fixation; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008349:Manipulation, Orthopedic; D011182:Postoperative Care / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States