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Published in: Archives of Orthopaedic and Trauma Surgery 10/2013

01-10-2013 | Orthopaedic Surgery

Evaluation of reduction and fixation of calcaneal fractures: a Delphi consensus

Authors: M. S. H. Beerekamp, J. S. K. Luitse, D. T. Ubbink, M. Maas, N. W. L. Schep, J. C. Goslings

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2013

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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.

Conclusion

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.
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Literature
1.
go back to reference Badillo K, Pacheco JA, Padua SO, Gomez AA, Colon E, Vidal JA (2011) Multidetector CT evaluation of calcaneal fractures. Radiographics 31:81–92PubMedCrossRef Badillo K, Pacheco JA, Padua SO, Gomez AA, Colon E, Vidal JA (2011) Multidetector CT evaluation of calcaneal fractures. Radiographics 31:81–92PubMedCrossRef
2.
go back to reference Bajammal S, Tornetta P III, Sanders D, Bhandari M (2005) Displaced intra-articular calcaneal fractures. J Orthop Trauma 19:360–364PubMed Bajammal S, Tornetta P III, Sanders D, Bhandari M (2005) Displaced intra-articular calcaneal fractures. J Orthop Trauma 19:360–364PubMed
3.
go back to reference Bakx R, Emous M, Legemate DA, Machado M, Zoetmulder FA, van Tets WF, Bemelman WA, Slors JF, van Lanschot JJ (2006) Categorization of major and minor complications in the treatment of patients with resectable rectal cancer using short-term pre-operative radiotherapy and total mesorectal excision: a Delphi round. Colorectal Dis 8:302–308PubMedCrossRef Bakx R, Emous M, Legemate DA, Machado M, Zoetmulder FA, van Tets WF, Bemelman WA, Slors JF, van Lanschot JJ (2006) Categorization of major and minor complications in the treatment of patients with resectable rectal cancer using short-term pre-operative radiotherapy and total mesorectal excision: a Delphi round. Colorectal Dis 8:302–308PubMedCrossRef
4.
go back to reference Basile A (2012) Subjective results after surgical treatment for displaced intra-articular calcaneal fractures. J Foot Ankle Surg 51:182–186PubMedCrossRef Basile A (2012) Subjective results after surgical treatment for displaced intra-articular calcaneal fractures. J Foot Ankle Surg 51:182–186PubMedCrossRef
5.
go back to reference Beerekamp MS, Haverlag R, Ubbink DT, Luitse JS, Ponsen KJ, Goslings JC (2011) How to evaluate the quality of fracture reduction and fixation of the wrist and ankle in clinical practice: a Delphi consensus. Arch Orthop Trauma Surg 131:739–746PubMedCrossRef Beerekamp MS, Haverlag R, Ubbink DT, Luitse JS, Ponsen KJ, Goslings JC (2011) How to evaluate the quality of fracture reduction and fixation of the wrist and ankle in clinical practice: a Delphi consensus. Arch Orthop Trauma Surg 131:739–746PubMedCrossRef
9.
go back to reference Beerekamp MS, Ubbink DT, Maas M, Luitse JS, Kloen P, Blokhuis TJ, Segers MJ, Marmor M, Schep NW, Dijkgraaf MG, Goslings JC (2011) Fracture Surgery of the extremities with the intra-operative use of 3D-RX: a randomized multicenter trial (EF3X-trial). BMC Musculoskelet Disord 12:151PubMedCrossRef Beerekamp MS, Ubbink DT, Maas M, Luitse JS, Kloen P, Blokhuis TJ, Segers MJ, Marmor M, Schep NW, Dijkgraaf MG, Goslings JC (2011) Fracture Surgery of the extremities with the intra-operative use of 3D-RX: a randomized multicenter trial (EF3X-trial). BMC Musculoskelet Disord 12:151PubMedCrossRef
10.
go back to reference Böhler L (1931) Diagnosis, pathology and treatment of the os calcis. J Bone Joint Surg Br 75:196–201 Böhler L (1931) Diagnosis, pathology and treatment of the os calcis. J Bone Joint Surg Br 75:196–201
12.
go back to reference Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R (2002) Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 84-A:1733–1744PubMed Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R (2002) Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 84-A:1733–1744PubMed
13.
go back to reference Clint SA, Morris TP, Shaw OM, Oddy MJ, Rudge B, Barry M (2010) The reliability and variation of measurements of the os calcis angles in children. J Bone Joint Surg Br 92:571–575PubMed Clint SA, Morris TP, Shaw OM, Oddy MJ, Rudge B, Barry M (2010) The reliability and variation of measurements of the os calcis angles in children. J Bone Joint Surg Br 92:571–575PubMed
14.
go back to reference Daftary A, Haims AH, Baumgaertner MR (2005) Fractures of the calcaneus: a review with emphasis on CT. Radiographics 25:1215–1226PubMedCrossRef Daftary A, Haims AH, Baumgaertner MR (2005) Fractures of the calcaneus: a review with emphasis on CT. Radiographics 25:1215–1226PubMedCrossRef
15.
go back to reference Dhillon MS, Bali K, Prabhakar S (2011) Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg 95:171–181PubMedCrossRef Dhillon MS, Bali K, Prabhakar S (2011) Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg 95:171–181PubMedCrossRef
16.
go back to reference Gupta A, Ghalambor N, Nihal A, Trepman E (2003) The modified Palmer lateral approach for calcaneal fractures: wound healing and postoperative computed tomographic evaluation of fracture reduction. Foot Ankle Int 24:744–753PubMed Gupta A, Ghalambor N, Nihal A, Trepman E (2003) The modified Palmer lateral approach for calcaneal fractures: wound healing and postoperative computed tomographic evaluation of fracture reduction. Foot Ankle Int 24:744–753PubMed
17.
go back to reference Holey EA, Feeley JL, Dixon J, Whittaker VJ (2007) An exploration of the use of simple statistics to measure consensus and stability in Delphi studies. BMC Med Res Methodol 7:52PubMedCrossRef Holey EA, Feeley JL, Dixon J, Whittaker VJ (2007) An exploration of the use of simple statistics to measure consensus and stability in Delphi studies. BMC Med Res Methodol 7:52PubMedCrossRef
18.
go back to reference Huisstede BM, Miedema HS, Verhagen AP, Koes BW, Verhaar JA (2007) Multidisciplinary consensus on the terminology and classification of complaints of the arm, neck and/or shoulder. Occup Environ Med 64:313–319PubMedCrossRef Huisstede BM, Miedema HS, Verhagen AP, Koes BW, Verhaar JA (2007) Multidisciplinary consensus on the terminology and classification of complaints of the arm, neck and/or shoulder. Occup Environ Med 64:313–319PubMedCrossRef
19.
go back to reference Kurozumi T, Jinno Y, Sato T, Inoue H, Aitani T, Okuda K (2003) Open reduction for intra-articular calcaneal fractures: evaluation using computed tomography. Foot Ankle Int 24:942–948PubMed Kurozumi T, Jinno Y, Sato T, Inoue H, Aitani T, Okuda K (2003) Open reduction for intra-articular calcaneal fractures: evaluation using computed tomography. Foot Ankle Int 24:942–948PubMed
20.
go back to reference McKee M, Priest P, Ginzler M, Black N (1991) How representative are members of expert panels? Qual Assur Health Care 3:89–94PubMedCrossRef McKee M, Priest P, Ginzler M, Black N (1991) How representative are members of expert panels? Qual Assur Health Care 3:89–94PubMedCrossRef
21.
go back to reference Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CF, Askham J, Marteau T (1998) Consensus development methods, and their use in clinical guideline development. Health Technol Assess 2:i-88 Murphy MK, Black NA, Lamping DL, McKee CM, Sanderson CF, Askham J, Marteau T (1998) Consensus development methods, and their use in clinical guideline development. Health Technol Assess 2:i-88
22.
go back to reference Paley D, Hall H (1993) Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors. J Bone Joint Surg Am 75:342–354PubMed Paley D, Hall H (1993) Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors. J Bone Joint Surg Am 75:342–354PubMed
23.
go back to reference Parmar HV, Triffitt PD, Gregg PJ (1993) Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study. J Bone Joint Surg Br 75:932–937PubMed Parmar HV, Triffitt PD, Gregg PJ (1993) Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study. J Bone Joint Surg Br 75:932–937PubMed
24.
go back to reference Queitsch C, Schulz AP, Haustedt N, Simon L, Fuchs S (2006) Improved therapy of calcaneal fractures by intraoperative 3D-fluoroscopy and locked-screw plate fixation. Eur J Trauma 32(5):471–476CrossRef Queitsch C, Schulz AP, Haustedt N, Simon L, Fuchs S (2006) Improved therapy of calcaneal fractures by intraoperative 3D-fluoroscopy and locked-screw plate fixation. Eur J Trauma 32(5):471–476CrossRef
25.
go back to reference Richards PJ, Bridgman S (2001) Review of the radiology in randomised controlled trials in open reduction and internal fixation (ORIF) of displaced intraarticular calcaneal fractures. Injury 32:633–636PubMedCrossRef Richards PJ, Bridgman S (2001) Review of the radiology in randomised controlled trials in open reduction and internal fixation (ORIF) of displaced intraarticular calcaneal fractures. Injury 32:633–636PubMedCrossRef
26.
go back to reference Rubberdt A, Feil R, Stengel D, Spranger N, Mutze S, Wich M, Ekkernkamp A (2006) The clinical use of the ISO-C(3D) imaging system in calcaneus fracture surgery. Unfallchirurg 109:112–118PubMedCrossRef Rubberdt A, Feil R, Stengel D, Spranger N, Mutze S, Wich M, Ekkernkamp A (2006) The clinical use of the ISO-C(3D) imaging system in calcaneus fracture surgery. Unfallchirurg 109:112–118PubMedCrossRef
27.
go back to reference Ruedi TP, Buckley RE, Moran CG (2007) AO principles of fracture management. Thieme, Stuttgart Ruedi TP, Buckley RE, Moran CG (2007) AO principles of fracture management. Thieme, Stuttgart
28.
go back to reference Sanders R (1992) Intra-articular fractures of the calcaneus: present state of the art. J Orthop Trauma 6:252–265PubMedCrossRef Sanders R (1992) Intra-articular fractures of the calcaneus: present state of the art. J Orthop Trauma 6:252–265PubMedCrossRef
29.
go back to reference Sanders R (2000) Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 82:225–250PubMed Sanders R (2000) Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 82:225–250PubMed
30.
go back to reference Schepers T, Ginai AZ, Mulder PG, Patka P (2007) Radiographic evaluation of calcaneal fractures: to measure or not to measure. Skeletal Radiol 36:847–852PubMedCrossRef Schepers T, Ginai AZ, Mulder PG, Patka P (2007) Radiographic evaluation of calcaneal fractures: to measure or not to measure. Skeletal Radiol 36:847–852PubMedCrossRef
31.
go back to reference Swanson SA, Clare MP, Sanders RW (2008) Management of intra-articular fractures of the calcaneus. Foot Ankle Clin 13:659–678PubMedCrossRef Swanson SA, Clare MP, Sanders RW (2008) Management of intra-articular fractures of the calcaneus. Foot Ankle Clin 13:659–678PubMedCrossRef
32.
go back to reference Walde TA, Sauer B, Degreif J, Walde HJ (2008) Closed reduction and percutaneous Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique, complications, clinical and radiological results after 2-10 years. Arch Orthop Trauma Surg 128:585–591PubMedCrossRef Walde TA, Sauer B, Degreif J, Walde HJ (2008) Closed reduction and percutaneous Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique, complications, clinical and radiological results after 2-10 years. Arch Orthop Trauma Surg 128:585–591PubMedCrossRef
Metadata
Title
Evaluation of reduction and fixation of calcaneal fractures: a Delphi consensus
Authors
M. S. H. Beerekamp
J. S. K. Luitse
D. T. Ubbink
M. Maas
N. W. L. Schep
J. C. Goslings
Publication date
01-10-2013
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2013
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-013-1823-5

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