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

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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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References

  1. Badillo K, Pacheco JA, Padua SO, Gomez AA, Colon E, Vidal JA (2011) Multidetector CT evaluation of calcaneal fractures. Radiographics 31:81–92

    Article  PubMed  Google Scholar 

  2. Bajammal S, Tornetta P III, Sanders D, Bhandari M (2005) Displaced intra-articular calcaneal fractures. J Orthop Trauma 19:360–364

    PubMed  Google Scholar 

  3. 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 8:302–308

    Article  PubMed  CAS  Google Scholar 

  4. Basile A (2012) Subjective results after surgical treatment for displaced intra-articular calcaneal fractures. J Foot Ankle Surg 51:182–186

    Article  PubMed  Google Scholar 

  5. 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 131:739–746

    Article  PubMed  CAS  Google Scholar 

  6. Beerekamp MS, Luitse JS (2012) Delphi consensus calcaneus—round 1. http://www.enqueteviainternet.nl/Delphi_consensus_calcaneus_round_1. Ref Type: Online Source

  7. Beerekamp MS, Luitse JS (2012) Delphi consensus calcaneus—round 2. http://www.enqueteviainternet.nl/Delphi_consensus_calcaneus_round_2. Ref Type: Online Source

  8. Beerekamp MS, Luitse JS (2012) Delphi consensus calcaneus—round 3. http://www.enqueteviainternet.nl/Delphi_consensus_calcaneus_round_3. Ref Type: Online Source

  9. 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 12:151

    Article  PubMed  Google Scholar 

  10. Böhler L (1931) Diagnosis, pathology and treatment of the os calcis. J Bone Joint Surg Br 75:196–201

    Google Scholar 

  11. Brown B (1968) Delphi process: a methodology used for the elicitation of opinions of experts. http://www.rand.org/pubs/papers/P3925.html P-3925. www.rand.org, last accessed February 2012. Ref Type: Online Source

  12. 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:1733–1744

    PubMed  Google Scholar 

  13. 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 92:571–575

    PubMed  CAS  Google Scholar 

  14. Daftary A, Haims AH, Baumgaertner MR (2005) Fractures of the calcaneus: a review with emphasis on CT. Radiographics 25:1215–1226

    Article  PubMed  Google Scholar 

  15. Dhillon MS, Bali K, Prabhakar S (2011) Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg 95:171–181

    Article  PubMed  Google Scholar 

  16. 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 24:744–753

    PubMed  Google Scholar 

  17. 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 7:52

    Article  PubMed  Google Scholar 

  18. 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 64:313–319

    Article  PubMed  CAS  Google Scholar 

  19. 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 24:942–948

    PubMed  Google Scholar 

  20. McKee M, Priest P, Ginzler M, Black N (1991) How representative are members of expert panels? Qual Assur Health Care 3:89–94

    Article  PubMed  CAS  Google Scholar 

  21. 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

    Google Scholar 

  22. Paley D, Hall H (1993) Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors. J Bone Joint Surg Am 75:342–354

    PubMed  CAS  Google Scholar 

  23. 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 75:932–937

    PubMed  CAS  Google Scholar 

  24. 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):471–476

    Article  Google Scholar 

  25. 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 32:633–636

    Article  PubMed  CAS  Google Scholar 

  26. 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 109:112–118

    Article  PubMed  CAS  Google Scholar 

  27. Ruedi TP, Buckley RE, Moran CG (2007) AO principles of fracture management. Thieme, Stuttgart

    Google Scholar 

  28. Sanders R (1992) Intra-articular fractures of the calcaneus: present state of the art. J Orthop Trauma 6:252–265

    Article  PubMed  CAS  Google Scholar 

  29. Sanders R (2000) Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 82:225–250

    PubMed  CAS  Google Scholar 

  30. Schepers T, Ginai AZ, Mulder PG, Patka P (2007) Radiographic evaluation of calcaneal fractures: to measure or not to measure. Skeletal Radiol 36:847–852

    Article  PubMed  CAS  Google Scholar 

  31. Swanson SA, Clare MP, Sanders RW (2008) Management of intra-articular fractures of the calcaneus. Foot Ankle Clin 13:659–678

    Article  PubMed  Google Scholar 

  32. 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 128:585–591

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank the following experts for their participation in this Delphi Study: A. Witteveen, MD, Orthopaedic Surgeon, Prof. Dr. B. Hintermann, MD Ph.D, Orthopaedic Surgeon, D. Den Hartog, MD Ph.D Trauma Surgeon, Prof. Thodarson, MD Ph.D, Orthopaedic Surgeon, Dr. H. Goost, MD Ph.D, Trauma Surgeon, Dr. M. Poeze, MD Ph.D, Trauma Surgeon, Prof. dr. P. Brink, MD Ph.D, Trauma Surgeon, Dr. S. Rammelt, MD Ph.D,Trauma Surgeon, Dr. I.G. Winson, MD Ph.D, Orthopaedic Surgeon, Dr. W.J. Harries, MD Ph.D, Orthopaedic Surgeon, Dr. J.B. Gerstner, MD Ph.D, Orthopaedic Surgeon, M. Andoljsek, MD, Trauma Surgeon, Dr. A. Karantanas, MD Ph.D, Radiologist, Dr. D.J. Wilson, MD Ph.D, Radiologist, Dr. F. Vanhoenacker, MD Ph.D, Radiologist, M. Obradov, MD, Radiologist, S.A. Schreinemachers, MD, Radiologist, Dr. O. Schoierer, MD Ph.D, Trauma Surgeon.

Conflict of interest

All authors declare to have no conflict of interest.

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Authors and Affiliations

  1. Trauma Unit, Department of Surgery, Academic Medical Center, P. O. Box 22660, 1100 DD, Amsterdam, The Netherlands

    M. S. H. Beerekamp, J. S. K. Luitse, N. W. L. Schep & J. C. Goslings

  2. Department of Quality and Process Innovation, Academic Medical Center, Amsterdam, The Netherlands

    D. T. Ubbink

  3. Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands

    M. Maas

Authors
  1. M. S. H. Beerekamp
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  2. J. S. K. Luitse
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  3. D. T. Ubbink
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  4. M. Maas
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  5. N. W. L. Schep
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  6. J. C. Goslings
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Corresponding author

Correspondence to M. S. H. Beerekamp.

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Beerekamp, M.S.H., Luitse, J.S.K., Ubbink, D.T. et al. Evaluation of reduction and fixation of calcaneal fractures: a Delphi consensus. Arch Orthop Trauma Surg 133, 1377–1384 (2013). https://doi.org/10.1007/s00402-013-1823-5

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  • DOI: https://doi.org/10.1007/s00402-013-1823-5

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