Identification of Postoperative Step-Offs and Gaps With Brodén’s View Following Open Reduction and Internal Fixation of Calcaneal Fractures

Abstract

Background: To date, there is no consensus regarding which postoperative imaging technique should be used after open reduction and internal fixation of an intra-articular calcaneal fracture. The aim of this study was to clarify whether Brodén’s view is sufficient as postoperative radiologic examination to assess step-offs and gaps of the posterior facet. Methods: Six observers estimated the size of step-offs and gaps on Brodén’s view in 42 surgically treated intra-articular calcaneal fractures. These findings were compared to postoperative CT scans (gold standard). Inter- and intraobserver reliability were calculated and compared using intraclass correlation coefficients (ICCs). Results: An accuracy of approximately 75% for both step-offs and gaps was found in foot and ankle experts. Less experienced observers correctly identified step-offs and gaps in approximately 62% of cases on fluoroscopy and in 48% on radiographs. Interobserver reliability for intraoperative fluoroscopy as well as postoperative radiographs was fair for step-offs, whereas interobserver reliability for gaps was excellent. Intraobserver reliability showed a low level of agreement for intraoperative fluoroscopy, in contrast to postoperative radiographs with excellent agreement for step-offs and good agreement for gaps. Conclusion: Our results show that especially for more experienced foot and ankle surgeons, in the majority of fractures, Brodén’s view accurately showed step-offs and gaps following open reduction and internal fixation. Interobserver reliability showed a fair level of agreement for step-offs and excellent agreement for gaps. Intraobserver reliability was only enough for radiographs, not for fluoroscopy. Level of Evidence: Level IV, case series.

Fracturas de calcáneo tipo IIC de Sanders en lengüeta: ¿Es la cirugía percutánea el tratamiento de elección? Evaluación funcional y radiográfica a corto plazo

“…Se usó la incidencia de Broden y axial de calcáneo intraoperatoria con intensificador de imágenes para constatar la reducción de la faceta posterior y el control de la osteosíntesis. 8 En el posoperatorio inmediato, se tomaron radiografías de pie, de frente y de perfil, sin carga y con carga a las semanas 6 y 12, y al final del seguimiento. En la radiografía lateral, se midió el ángulo de Böhler que consiste en dos líneas, una desde el punto más alto de la tuberosidad anterior al más alto de la faceta posterior y otra tangencial al borde superior de la tuberosidad posterior.…”

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“…При сопоставлении исходов лечения переломов пяточной кости типа Sanders II после ORIF из ELA с таковыми при CRIF благоприятные результаты отмечены более чем у 80% пациентов в обеих группах пациентов. При сопоставлении ORIF с CRIF Wang YM et al [68] [86], произведя КТ сканирование после минимально инвазивного остеосинтеза через STA доступ переломов III типа у 38 пациентов, установил, что смещение отломков более 3 мм имело место в 31% случаев, до 3 мм -в 69%. Данный недостаток в настоящее время можно избежать внедрением интраоперационной 3D визуализации при помощи Oarm дуги с последующим довправлением перелома [56, 59-61, 86, 87].…”

Understanding Radiographic Measurements Used in Foot and Ankle Surgery

“…Broden view may delineate step-offs and gaps on radiographic imaging compared with a benchmark CT scan. 22 Broden view is critical intraoperatively and is particularly important with more minimally invasive approaches to calcaneal fractures, such as the sinus tarsi approach, in restoration of the articular surfaces.…”