title: Three-dimensional computed tomography is not indicated for the classification and characterization of calcaneal fractures.
abstract: This study determined inter- and intra-observer reliability for measurement of the angles of Böhler and Gissane, for the decision between surgical or conservative management and for the three mostly used classification systems for calcaneal fractures with the use of 2D-CT imaging versus 2D- and 3D-CT imaging. A consecutive series of 38 fractures in 36 patients, treated at a level II trauma centre between 2005 and 2008, were evaluated in two rounds by five observers. We measured the inter- and intraobserver reliability for the Sanders', Zwipp and Essex-Lopresti classification systems using the kappa values as described by Cohen. The intraclass correlation coefficient as described by Shrout and Fleiss was used to analyze inter- and intra-observer reliability of the angles of Böhler and Gissane. Usage of 2D-CT imaging interobserver reliability was fair for the Sanders' and Zwipp classifications and for measurement of the angle of Gissane, and it was moderate for measurement of the Essex-Lopresti classification system and measurement of the angle of Böhler. With the addition of 3D-CT imaging, the interobserver reliability was fair for the Sanders', Zwipp and Essex-Lopresti classification systems. The intraobserver reliability was fair for measurement of the angle of Gissane and it was moderate for the Sanders', Zwipp and Essex-Lopresti classification systems and for the measurement of the angle of Böhler. The addition of three-dimensional CT imaging did not increase inter- and intraobserver reliability for the classification of calcaneal fractures. Authors commented they experienced no additional benefit from 3D-CT imaging for the assessment of calcaneal fractures.
authors: Orthopaedic Research Center, Amsterdam, The Netherlands. Electronic address: wout.veltman@gmail.com.
authors: Ewout S
authors: ES
authors: Veltman
authors: Onze Lieve Vrouwe Gasthuis Amsterdam, Orthopaedic Research Center, Amsterdam, The Netherlands.
authors: Michel P J
authors: MP
authors: van den Bekerom
authors: Academic Medical Center Amsterdam, Orthopaedic Research Center, Amsterdam, The Netherlands.
authors: Job N
authors: JN
authors: Doornberg
authors: Medisch Centrum Alkmaar, The Netherlands.
authors: Diederik O
authors: DO
authors: Verbeek
authors: Universitätsklinikum "Carl Gustav Carus", Dresden, Germany.
authors: Stefan
authors: S
authors: Rammelt
authors: St. Lucas-Andreas Ziekenhuis, Amsterdam, The Netherlands.
authors: Ernst Ph
authors: EP
authors: Steller
authors: AMC Trauma Unit, Academic Medical Center, Amsterdam, The Netherlands.
authors: Tim
authors: T
authors: Schepers
mesh_terms: D002111:Calcaneus / Q000000981:diagnostic imaging* / Q000293:injuries*; D005260:Female; D018409:Foot Injuries / Q000000981:diagnostic imaging*; D050723:Fractures, Bone / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D019564:Unnecessary Procedures
keywords: 3D CT imaging; Calcaneal fractures; Inter-observer reliability; Intra-observer reliability; Os calcis; Surgery; Trauma