Os calcis fractures: Analysis of interobserver variability in using sanders classification

Furey, Andrew; Stone, Craig; Squire, Daniel; Harnett, John D.

doi:10.1016/s1067-2516(03)70048-9

Cited by 30 publications

(20 citation statements)

References 6 publications

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“…Similar to previous studies,29,30) there was moderate inter and intraobserver reliability for the Sanders classification. Although the Sanders classification has some degree of variability and inconsistency in its interpretation among users, it showed moderate agreement among users, indicating a useful classification.…”

Section: Discussionsupporting

confidence: 88%

Revisit of Broden's View for Intraarticular Calcaneal Fracture

et al. 2012

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BackgroundThis study was performed to investigate the relationship between coronal computed tomography (CT) and Broden's view in terms of location of the fracture line and fracture pattern.MethodsForty-five feet of 45 patients with intraarticular calcaneal fractures were evaluated. The mean age of the patients was 46.3 years (standard deviation, 18.1; range, 15 to 80 years), and there were 34 men and 11 women. The Broden's views were acquired using the ray sum projection, reviewed, and correlated with the coronal CT image to determine the location of the fracture on the posterior facet and fracture pattern described by the Sanders classification. The quantified location of the fracture line was defined as the distance between the medial margin of posterior facet and the fracture line divided by the whole length of the posterior facet, which was expressed as a percentage.ResultsThe fracture line on the Broden's view was positioned at 22.3% (standard deviation, 29.6) laterally compared to that on coronal CT (p < 0.01). Although all cases showed posterior facet involvement on the CT scan, the fracture line was positioned lateral to the posterior facet in 6 cases (13.3%) in the Broden's view. The coronal CT and Broden's view showed a low level of agreement in the fracture pattern according to the Sanders classification, with kappa values of 0.23.ConclusionsSurgeons should consider that the fracture line on the Broden's view shows positioning laterally compared to coronal CT and they should consider that the fracture line at the lateral to posterior facet on the Broden's view might be an intraarticular fracture line. There are some limitations when applying the Sanders classification with the Broden's view.

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Section: Discussionsupporting

confidence: 88%

Revisit of Broden's View for Intraarticular Calcaneal Fracture

et al. 2012

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“…That study reported a mean weighted kappa value of 0.48 with a 95% confidence interval of 0.37 to 0.59. 15 The 95% confidence intervals for that study and the present study overlap, leading to the conclusion that interobserver reliability was not significantly different in the 2 studies. This is interesting, particularly because the methods in the 2 studies were remarkably different; the previous study 15 used full CT data and provided unlimited time for observers to review that data, whereas the present study presented only a single CT scan cut and observers required an average of 1 minute per fracture to reach a classification decision.…”

Section: Discussionmentioning

confidence: 43%

“…[12][13][14][15][16] One of the reasons that CT scans are used is that physicians perceive that fracture fragments and fracture lines are much more clearly and accurately demonstrated with this modality than with plain radiographs. More recently devised fracture classification systems, such as the Sanders classification for calcaneus fractures, 26 are based on CT images.…”

Section: Discussionmentioning

confidence: 99%

“…Comparisons between the 2 studies should be made cautiously, however, because the previous study used only 4 observers, none of the observers were traumatologists, and the specific imaging planes presented to the observers were not reported. 15 The present study used 10 observers, all of whom were traumatologists with a minimum of 5 years of experience, and presented a single, carefully defined, semicoronal CT image for classification.…”

Section: Discussionmentioning

confidence: 99%

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Interobserver Reliability of a CT-Based Fracture Classification System

Humphrey

Dirschl²,

Ellis³

2005

Journal of Orthopaedic Trauma

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The results indicate that in a carefully controlled paradigm, the interobserver reliability with a classification system based on interpretation of a single, carefully defined CT image was no better than the results reported for the same classification system used with full CT data or for other classification systems used for various fractures in the skeleton. Agreement in identifying the location of the fracture lines was very good for simple fractures but much worse for complex injuries. Additional study may determine whether the use of a full complement of CT images can improve reliability in classification of complex injuries.

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“…Our results do not match the conclusions reached by Furey et al 10 who found the interobserver variation to be 0.56 (0.32 in our study) for the classification system as a whole and 0.48 (0.33 in our study) when the subclasses were combined. This could partly be explained by the fact that our study had more observers than that of Furey et al 10 This difference in the values between the two studies itself emphasises the variability of the system. Additionally, our study shows that intra-observer reliability varies widely among different orthopaedic surgeons which defeats the purpose of a classification system.…”

Section: Discussionmentioning

confidence: 99%

Sanders classification of fractures of the os calcis

Bhattacharya

Vassan

Finn

et al. 2005

The Journal of Bone and Joint Surgery. British volume

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Our study was undertaken to assess the inter- and intra-observer variability of the classification system of Sanders for calcaneal fractures. Five consultant orthopaedic surgeons with different subspecialty interests classified CT scans of 28 calcaneal fractures using this classification system. After six months, they reclassified the scans. Kappa statistics were used to analyse the two groups. The interobserver variability of the classification system was 0.32 (95% confidence interval (CI) 0.26 to 0.38). The subclasses were then combined and assessment of agreement between the general classes as a whole gave a kappa value of 0.33 (95% CI 0.25 to 0.41). The mean kappa value for intra-observer variability of the classification system was 0.42 (95% CI 0.22 to 0.62). When the subclasses were combined, it was 0.45 (95% CI 0.21 to 0.65). Our results show that, despite its popularity, the classification system of Sanders has only fair agreement among users.

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Os calcis fractures: Analysis of interobserver variability in using sanders classification

Cited by 30 publications

References 6 publications

Revisit of Broden's View for Intraarticular Calcaneal Fracture

Revisit of Broden's View for Intraarticular Calcaneal Fracture

Interobserver Reliability of a CT-Based Fracture Classification System

Sanders classification of fractures of the os calcis

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