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Os calcis fractures: Analysis of interobserver variability in using sanders classification
Authors:Andrew Furey MD   Craig Stone MD   FRCS   Daniel Squire MD   FRCS  John Harnett MB   BCh   MRCPI   FRCPC
Affiliation:Faculty of Medicine, Department of Orthopedic Surgery, Memorial University of Newfoundland, St. John's, Newfoundland. andrewfurey@hotmail.com
Abstract:
The os calcis is the most frequently fractured tarsal bone. In 1992 Sanders developed a classification system based on coronal and axial computed tomography (CT) scans of the calcaneus. This classification is the one used most frequently today in treatment decision making and reporting of results. The objective of this study was to assess the degree of interobserver variability in using this classification system. Thirty CTs of calcaneal fractures were chosen randomly from the past 5 years in 2 tertiary care centers. The CTs were reviewed by 3 orthopedic surgeons and one senior orthopedic resident who classified the fractures according to Sanders' classification. The results were first tabulated and analyzed by using a weighted kappa test including the subcategories. The weighted kappa value achieved was.56, with a 95% confidence interval of.45-.67. The subcategories of the classification were then further combined and a second weighted kappa test was performed to assess agreement between general classes. The weighted kappa value achieved was.48, with a 95% confidence interval of 0.37-0.59. We concluded that Sanders' classification system did prove to achieve moderate agreement among users, thus representing a useful classification system.
Keywords:os calcis fractures   calcaneus fractures   Sanders classification   CT scan
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