Inter-rater reliability of Böhler and Gissane angles in different calcaneal fracture according to the Essex-Lopresti and Sanders classifications

Objective: To evaluate the inter-rater reliability and intra-class correlation coefficients (ICC) of Böhler’s angle and the critical angle of Gissane in calcaneal fractures, stratified by severity and by the Essex-Lopresti and Sanders classifications. Methods: Retrospective study of radiographs obtained from 97 patients: 67 with calcaneal fractures and 30 with normal lateral radiographs (used as a control group). Böhler’s angle and the angle of Gissane were measured by six raters: two orthopedic surgery residents, two musculoskeletal radiologists, a foot and ankle surgery fellow, and a senior consultant in foot surgery. Statistical analysis of inter-rater reliability was performed for the two angles, in the sample overall and stratified by the different radiographic and CT subtypes of calcaneal fractures. Results: For the angle of Gissane, the ICC was at best 0.400 (95% CI: 0.250 to 0.581) for normal radiographs, with poor agreement across all classifications and severity stratifications. For Böhler’s angle, the ICC values indicated weak to moderate agreement, with the best reproducibility obtained for the overall sample (0.740; 95% CI: 0.673 to 0.801). In Sanders type 1 fractures, the ICC was 0.704 (95% CI: 0.397 to 0.940), and in Sanders type 2 fractures, 0.762 (95% CI: 0.634 to 0.870). Conclusion: Böhler’s angle is more reproducible than the critical angle of Gissane, with greater inter-rater reliability among fractures deemed less severe on the Sanders classification, although the overall ICC ranged from weak to moderate at best. Level of Evidence III; Case Control Study; Diagnostic Studies.

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Restoring the Anatomy of Calcaneal Fractures: A Simple Technique With Radiographic Review

Foot & Ankle Specialist ◽

10.1177/1938640016679700 ◽

2016 ◽

Vol 10 (3) ◽

pp. 235-239 ◽

Cited By ~ 2

Author(s):

James M. Cottom ◽

Joseph S. Baker

Keyword(s):

Critical Angle ◽

Simple Technique ◽

Varus Deformity ◽

Mean Difference ◽

Calcaneal Fractures ◽

Articular Fractures ◽

Anatomic Reduction ◽

Surgical Fixation ◽

The Mean ◽

Böhler’S Angle

Displaced, intra-articular fractures of the calcaneus result in gross deformity of the hindfoot, which must be reduced during surgical fixation. Described techniques aimed at restoring the normal anatomy of the calcaneus have mostly been focused on percutaneous methods, which are not without complication. Described in this report is a method of anatomic reduction during open reduction and internal fixation of these injuries, which uses a lamina spreader to simultaneously reduce calcaneal varus, restore calcaneal height, reduce the subtalar joint, and restore normal calcaneal width. Additionally, 6 patients with 7 calcaneal fractures were identified that underwent this technique, and radiographic review was performed. Varus deformity of the calcaneus was measured as 93.8 ± 4.3° (range 88.1° to 100.5°) preoperatively and 83.3 ± 3.7° (range 77.8° to 89.4°) postoperatively, with a mean difference of 10.9 ± 5.6° (range 1.3° to 17.3°; P = .0564). Bohler’s angle was measured as 16.5 ± 16.9° (range −7.5° to 37.9°) preoperatively and 33.3 ± 12.5° (range 20.5° to 54.5°) postoperatively, the mean difference being 16.7 ± 15.0° (range 0.4° to 39.9°; P = .0288). Critical angle of Gissane was measured as 108.8 ± 14.0° (range 93.1° to 132.4°) preoperatively and 123.3 ± 6.6° (range 113.9° to 134.4°) postoperatively, with a mean difference of 16.2 ± 9.1° (range 5.8° to 29.7°; P = .0004). Levels of Evidence: Level IV: Retrospective

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Correlation between the quality of calcaneal fracture reduction and time to return to work

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2018.v12.837 ◽

2018 ◽

Vol 12 (4) ◽

pp. 304-09

Author(s):

Fabielle Patrícia Zanardini Motizuki ◽

Juliano Rodrigo Martynetz ◽

Mário Fábio Polati ◽

Sidney Silva de Paula ◽

Afonso Klein Júnior ◽

...

Keyword(s):

Surgical Treatment ◽

Return To Work ◽

Functional Limitation ◽

Calcaneal Fracture ◽

Late Complications ◽

Fracture Reduction ◽

Joint Involvement ◽

Calcaneal Fractures ◽

Level Of Evidence

Objective: The aim of this study is to test the hypothesis that patients with calcaneal fractures who are surgically treated and have Böhler and Gissane angles restored to normal have a faster return to work than patients without restoration of these angles. Calcaneal fractures represent 1-2% of all fractures, and approximately 75% of these are articular, indicating surgical treatment. Joint involvement results in functional limitation and can lead to late complications such as chronic pain, subtalar arthrosis, difficulty walking, and deformities. Methods: Lateral radiographs of the calcaneus of 44 patients who underwent surgical treatment for calcaneal fracture during the period from 2014 to 2016 were analysed to measure the Böhler and Gissane angles and to evaluate the association of their restoration to normal with the time to return to work. Results: Among the patients, 70.2% presented restoration of the Böhler angle and 44.7% presented restoration of the Gissane angle with surgery. The mean time away from work was 8.38 months. A total of 76.6% of patients returned to the same function. Patients who had good fracture reduction had a shorter time to return to work, but this result was not statistically significant. Conclusion: Surgical restoration of angles can positively influence the functional outcomes of patients, but this is not the only variable and thus should not be exclusively used to analyse the functional outcome and time to return to work of patients. Level of Evidence III; Therapeutic Studies; Cases Series.

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Plantar Medial Avulsion Fragment Associated With Tongue-Type Calcaneus Fractures

Foot & Ankle International ◽

10.1177/1071100719830948 ◽

2019 ◽

Vol 40 (6) ◽

pp. 634-640 ◽

Cited By ~ 1

Author(s):

Mark R. Adams ◽

Kenneth L. Koury ◽

Jaydev B. Mistry ◽

William Braaksma ◽

John S. Hwang ◽

...

Keyword(s):

Retrospective Chart Review ◽

Plantar Fascia ◽

Calcaneal Fractures ◽

Level Of Evidence ◽

Fracture Fragment ◽

Avulsion Fractures ◽

Distinct Level ◽

Level I ◽

Calcaneus Fractures ◽

Essex Lopresti

Background: The plantar fascia attaches to the tuberosity of the calcaneus, which produces a distinct plantar medial avulsion (PMA) fracture fragment in certain calcaneal fractures. We hypothesized that tongue-type fractures, as described by the Essex-Lopresti classification, were more likely to be associated with this PMA fracture than joint depression fractures. Methods: A retrospective chart review was performed at 2 distinct Level I trauma centers to identify patients sustaining calcaneal fractures. Radiographs were then reviewed to determine the Essex-Lopresti classification, OTA classification, and presence of a PMA fracture. Results: The review yielded 271 total patients with 121 (44.6%) tongue-type (TT), 110 (40.6%) joint depression (JD), and 40 (14.8%) fractures not classifiable by the Essex-Lopresti classification. In the TT group, 73.6% of the patients had the PMA fracture whereas only 8.2% of JD and 15.0% of nonclassifiable fractures demonstrated a PMA fragment ( P < .001). Conclusion: Plantar medial avulsion fractures occurred in 38.4% of the calcaneal fractures reviewed with a significantly greater proportion occurring in TT (73.6%) as opposed to JD (8.2%). Given the plantar fascia attachment to the PMA fragment, there may be clinical significance to identifying this fracture and changing treatment management; however, this requires further investigation. Level of Evidence: Level III, comparative study.

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A comparative study of operative and conservative treatment of intraarticular displaced calcaneal fractures

Scientific Reports ◽

10.1038/s41598-021-83636-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

K. Ramachandra Kamath ◽

Sharan Mallya ◽

Atmananda Hegde

Keyword(s):

Operative Treatment ◽

Calcaneal Fracture ◽

Calcaneal Fractures ◽

American Orthopaedic ◽

One Year ◽

A Prospective Study ◽

Operative And Conservative Treatment ◽

Böhler’S Angle ◽

Better Than

AbstractThe treatment of intra-articular displaced calcaneal fracture is debatable. We conducted a prospective study to compare operative and non-operative treatment for intra-articular displaced calcaneal fractures. Patients were assigned to two groups based on the treatment given (operative and nonoperative) and were regularly followed for a period of 1 year. The outcome measures were assessed by Modified Rowe’s Score (MRS), Visual Analogue e Scale (VAS) and The American Orthopaedic Foot and Ankle Society (AOFAS) scale. The outcome related to patient’s job was noted after one year and compared with pre-injury status. Fifty five patients with 61 calcaneal fractures were studied. Thirty of them were operated and 31 were treated conservatively. Out of 30 operated cases, Bohler’s angle was restored in 25 cases and these had good results with all three outcome scores at 1 year follow up and remaining 5 cases showed fair results (Mean MRS: 74.783, VAS: 3.348, AOFAS: 78.783). Thirty one cases treated with cast also showed fair results (Mean MRS: 57.368, VAS: 4.944, AOFAS: 71.211). The overall outcome of operated cases were better than non-operated cases (unpaired T test MRS: 5.807 p < 0.001, VAS: 4.387 p < 0.001, AOFAS: 2.728 p = 0.008) . Operative treatment of displaced intra-articular calcaneal fractures gave good results at one year follow up, provided Bohler’s angle was restored to normal range. Non operative treatment gave fair results. Complications were seen both with operative and non-operative treatment.

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COMPARISON OF LCP AND INTRAMEDULLARY NAIL OSTEOSYNTHESIS IN CALCANEAL FRACTURES

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192706223193 ◽

2019 ◽

Vol 27 (6) ◽

pp. 288-293 ◽

Cited By ~ 1

Author(s):

Jaroslav Zeman ◽

Petr Zeman ◽

Tomas Matejka ◽

Jaroslav Belatka ◽

Jiri Matejka

Keyword(s):

Minimally Invasive ◽

Calcaneal Fractures ◽

Post Injury ◽

Level Of Evidence ◽

Mean Values ◽

First Choice ◽

Invasive Method ◽

The Mean ◽

Nail Osteosynthesis ◽

Böhler’S Angle

ABSTRACT Objective: This study compared groups of patients with calcaneal fractures of Sanders types II and III. One group was treated with ORIF using an LCP (plate), while the second was treated with a minimally invasive method using a C-Nail. Methods: The study included 217 patients in the ORIF group and 19 patients in the minimally invasive nail osteosynthesis group. Results: In the LCP group, the outcomes were excellent for 35.7% of the patients; good, 38.9%; satisfactory, 19.7%; and poor, 5.7%. In the C-Nail group, the outcomes were excellent for 36.9% of the patients; good; 31.6%; satisfactory, 21%; and poor, 10.2%. The mean values of the restoration of Böhler's angle from post-injury were 6.8° to 32.3° in the LCP group and 7.1° to 33.3° in the C-Nail group. After 12 months, there was only a minimal decrease in Böhler's angle to 29.2° in both the LCP and C-Nail groups. Conclusion: The outcomes obtained with C-Nail fixation are statistically identical to those obtained with LCP fixation. We conclude that osteosynthesis with a C-Nail is suitable as the first-choice treatment for Sanders types II and III fractures. Level of evidence IV, retrospective observational study.

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Intra and Inter-Rater Reliability and Convergent Validity of FIT-HaNSA in Individuals with Grade П Whiplash Associated Disorder

The Open Orthopaedics Journal ◽

10.2174/1874325001610010179 ◽

2016 ◽

Vol 10 (1) ◽

pp. 179-189 ◽

Cited By ~ 1

Author(s):

Michael Pierrynowski ◽

Colleen McPhee ◽

Saurabh P. Mehta ◽

Joy C. MacDermid ◽

Anita Gross

Keyword(s):

Construct Validity ◽

Rating Scale ◽

Motor Vehicle ◽

Intraclass Correlation ◽

Neck Disability Index ◽

Correlation Coefficients ◽

Control Group ◽

Healthy Controls ◽

Rater Reliability ◽

Study Results

Background: Whiplash-Associated Disorders (WAD) are common following a motor vehicle accident. The Functional Impairment Test - Hand, and Neck/Shoulder/Arm (FIT-HaNSA) assesses upper extremity physical performance. It has been validated in patients with shoulder pathology but not in those with WAD. Objectives: Establish the Intra and inter-rater reliability and the known-group and construct validity of the FIT-HaNSA in patients with Grade II WAD (WAD2). Methods: Twenty-five patients with WAD2 and 41 healthy controls were recruited. Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI), Disabilities of the Arm, Shoulder and Hand (DASH), cervical range of motion (CROM), and FIT-HaNSA were completed at two sessions conducted 2 to 7 days apart by two raters. Intraclass correlation coefficients (ICC) were used to describe Intra and inter-rater reliability. Spearman rank correlation coefficients (ρ) were used to quantify the associations between scores of the FIT-HaNSA and other measures in the WAD2 group (convergent construct validity). Results: The Intra and inter-ICCs for the FIT-HaNSA scores ranged from 0.88 to 0.89 in the control group and 0.78 to 0.85 in the WAD2 group. Statistically significant differences in FIT-HaNSA performance between the two groups suggested known group construct validity (P < 0.001). The correlations between the NPRS, NDI, DASH, CROM and FIT-HaNSA were generally poor (ρ < 0.4). Conclusion: The study results indicate that the total FIT-HaNSA score has good Intra and inter-rater reliability and the construct validity in WAD2 and healthy controls.

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Patient-Reported Dysphagia in Adults with Eosinophilic Esophagitis: Translation and Validation of the Swedish Eosinophilic Esophagitis Activity Index

Dysphagia ◽

10.1007/s00455-021-10277-5 ◽

2021 ◽

Author(s):

Sofie Albinsson ◽

Lisa Tuomi ◽

Christine Wennerås ◽

Helen Larsson

Keyword(s):

Eosinophilic Esophagitis ◽

Activity Index ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Control Group ◽

Cronbach’S Alpha ◽

Intraclass Correlation Coefficients ◽

Cronbach's Alpha ◽

Patient Reported ◽

Eortc Qlq

AbstractThe lack of a Swedish patient-reported outcome instrument for eosinophilic esophagitis (EoE) has limited the assessment of the disease. The aims of the study were to translate and validate the Eosinophilic Esophagitis Activity Index (EEsAI) to Swedish and to assess the symptom severity of patients with EoE compared to a nondysphagia control group. The EEsAI was translated and adapted to a Swedish cultural context (S-EEsAI) based on international guidelines. The S-EEsAI was validated using adult Swedish patients with EoE (n = 97) and an age- and sex-matched nondysphagia control group (n = 97). All participants completed the S-EEsAI, the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Oesophageal Module 18 (EORTC QLQ-OES18), and supplementary questions regarding feasibility and demographics. Reliability and validity of the S-EEsAI were evaluated by Cronbach’s alpha and Spearman correlation coefficients between the domains of the S-EEsAI and the EORTC QLQ-OES18. A test–retest analysis of 29 patients was evaluated through intraclass correlation coefficients. The S-EEsAI had sufficient reliability with Cronbach’s alpha values of 0.83 and 0.85 for the “visual dysphagia question” and the “avoidance, modification and slow eating score” domains, respectively. The test–retest reliability was sufficient, with good to excellent intraclass correlation coefficients (0.60–0.89). The S-EEsAI domains showed moderate correlation to 6/10 EORTC QLQ-OES18 domains, indicating adequate validity. The patient S-EEsAI results differed significantly from those of the nondysphagia controls (p < 0.001). The S-EEsAI appears to be a valid and reliable instrument for monitoring adult patients with EoE in Sweden.

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Excess Opioid Disposal Following Orthopaedic Surgery: A Randomized Clinical Trial

Foot & Ankle Specialist ◽

10.1177/1938640020980921 ◽

2020 ◽

pp. 193864002098092

Author(s):

Cornelia Keyser ◽

Abhiram Bhashyam ◽

Abdurrahman Abdurrob ◽

Jeremy T. Smith ◽

Eric Bluman ◽

...

Keyword(s):

Lower Extremity ◽

Orthopaedic Surgery ◽

Control Group ◽

Foot And Ankle ◽

Opioid Medication ◽

Ankle Surgery ◽

Randomized Control ◽

Level I ◽

To Receive ◽

Experimental Group

Background Previous research indicates low disposal rates of excess postoperative narcotics, leaving them available for diversion or abuse. This study examined the effect of introducing a portable disposal device on excess opiate opioid disposal rates after lower extremity orthopaedic surgery. Methods This was a single site randomized control trial within an outpatient orthopaedic clinic. All patients 18 years or older, undergoing outpatient foot and ankle surgery between December 1, 2017 and August 1, 2018 were eligible. Patients were prospectively enrolled and randomized to receive standard opioid disposal instructions or a drug deactivation device at 2-week postoperative appointments. Participants completed an anonymous survey at 6-week postoperative appointments. Results Of the 75 patients surveyed, 68% (n = 26) of the experimental group and 56% (n = 21) of the control group had unused opioid medication. Of these, 84.6% of patients who were given Deterra Drug Deactivation System deactivation pouches safely disposed of excess medication, compared with 38% of controls (P = .003). When asked if they would use a disposal device for excess medication in the future, 97.4% (n = 37) of the experimental and 83.8% (n = 31) of the control group reported that they would. Conclusions Providing a portable disposal device with postoperative narcotic prescriptions may increase safe disposal rates of excess opioid medication following lower extremity orthopaedic surgery. Levels of Evidence Level I

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Quantitative Analysis of Deltoid Ligament Degradation in Patients With Chronic Ankle Instability Using Computed Tomographic Images

Foot & Ankle International ◽

10.1177/1071100721997070 ◽

2021 ◽

pp. 107110072199707

Author(s):

Yasunari Ikuta ◽

Tomoyuki Nakasa ◽

Junichi Sumii ◽

Akinori Nekomoto ◽

Nobuo Adachi

Keyword(s):

Ankle Instability ◽

Ct Images ◽

Chronic Ankle Instability ◽

Control Group ◽

Deltoid Ligament ◽

Anterior Talofibular Ligament ◽

Mri Findings ◽

Calcaneofibular Ligament ◽

Level Of Evidence ◽

Strong Negative Correlation

Background: Rotational ankle instability (RAI) is associated with the faster onset of severe ankle osteoarthritis via dysfunction of the anterior talofibular ligament, calcaneofibular ligament, and deltoid ligament. No specific clinical examination is available for RAI, and diagnostic imaging has limitations in evaluating ligament degradation. This study investigated the deltoid ligament degeneration using Hounsfield unit (HU) values on computed tomography (CT) images. Methods: Patients were enrolled in this retrospective analysis if they had undergone magnetic resonance imaging (MRI) and CT scans of the ankle. The chronic ankle instability (CAI) group comprised 20 ankles with CAI (9 men, 11 women; mean age, 28.7 years) and the control group comprised 28 ankles (16 men, 12 women, mean age, 41.3 years). The average HU values of the deep posterior tibiotalar ligament (dPTL) that constitutes the deltoid ligament were measured on coronal CT images, and MRI results were used as a reference. All patients were subdivided based on the MRI findings of dPTL injury such as fascicular disruption, irregularity, and the loss of striation. Results: A strong negative correlation was identified between age and HU values for all patients (Spearman ρ = −0.63; P < .001). The mean HU values of the dPTL for participants aged <60 years were 81.0 HU for the control group (21 ankles) and 69.5 HU for the CAI group ( P = .0075). No significant differences in the HU values were observed for the dPTL among the MRI subgroups. Conclusion: In addition to the conventional imaging examination such as stress radiographs and MRI, HU measurements of CT images could be useful for quantitatively and noninvasively evaluating degenerative changes in the deltoid ligament for CAI patients to assist the diagnosis of RAI. Level of Evidence: Level III. case-control study.

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Incidence and Risk Factors of Symptomatic Venous Thromboembolism Following Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100718794851 ◽

2018 ◽

Vol 40 (1) ◽

pp. 98-104 ◽

Cited By ~ 5

Author(s):

Johanna Marie Richey ◽

Miranda Lucia Ritterman Weintraub ◽

John M. Schuberth

Keyword(s):

Risk Factors ◽

Hormone Replacement ◽

Case Series ◽

Foot And Ankle ◽

Retrospective Case ◽

Level Of Evidence ◽

Ankle Surgery ◽

History Of ◽

Low Incidence ◽

Predictive Risk

Background: The incidence rate of venous thrombotic events (VTEs) following foot and ankle surgery is low. Currently, there is no consensus regarding postoperative prophylaxis or evidence to support risk stratification. Methods: A 2-part study assessing the incidence and factors for the development of VTE was conducted: (1) a retrospective observational cohort study of 22 486 adults to calculate the overall incidence following foot and/or ankle surgery from January 2008 to May 2011 and (2) a retrospective matched case-control study to identify risk factors for development of VTE postsurgery. One control per VTE case matched on age and sex was randomly selected from the remaining patients. Results: The overall incidence of VTE was 0.9%. Predictive risk factors in bivariate analyses included obesity, history of VTE, history of trauma, use of hormonal replacement or oral contraception therapy, anatomic location of surgery, procedure duration 60 minutes or more, general anesthesia, postoperative nonweightbearing immobilization greater than 2 weeks, and use of anticoagulation. When significant variables from bivariate analyses were placed into the multivariable regression model, 4 remained statistically significant: adjusted odds ratio (aOR) for obesity, 6.1; history of VTE, 15.7; use of hormone replacement therapy, 8.9; and postoperative nonweightbearing immobilization greater than 2 weeks, 9.0. The risk of VTE increased significantly with 3 or more risk factors ( P = .001). Conclusion: The overall low incidence of VTE following foot and ankle surgery does not support routine prophylaxis for all patients. Among patients with 3 or more risk factors, the use of chemoprophylaxis may be warranted. Level of Evidence: Level III, retrospective case series.

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