1 Trauma Unit, Amsterdam University Medical Center, Amsterdam, the Netherlands.
2 Department of Trauma Surgery, University Hospitals Leuven (UZ), Louvain, Belgium.
Foot Ankle Int. 2019 Jul;40(7):797-802. doi: 10.1177/1071100719840812. Epub 2019 Apr 8.
To date, there is no consensus regarding which postoperative imaging technique should be used after open reduction and internal fixation of an intra-articular calcaneal fracture. The aim of this study was to clarify whether Brodén's view is sufficient as postoperative radiologic examination to assess step-offs and gaps of the posterior facet.
Six observers estimated the size of step-offs and gaps on Brodén's view in 42 surgically treated intra-articular calcaneal fractures. These findings were compared to postoperative CT scans (gold standard). Inter- and intraobserver reliability were calculated and compared using intraclass correlation coefficients (ICCs).
An accuracy of approximately 75% for both step-offs and gaps was found in foot and ankle experts. Less experienced observers correctly identified step-offs and gaps in approximately 62% of cases on fluoroscopy and in 48% on radiographs. Interobserver reliability for intraoperative fluoroscopy as well as postoperative radiographs was fair for step-offs, whereas interobserver reliability for gaps was excellent. Intraobserver reliability showed a low level of agreement for intraoperative fluoroscopy, in contrast to postoperative radiographs with excellent agreement for step-offs and good agreement for gaps.
Our results show that especially for more experienced foot and ankle surgeons, in the majority of fractures, Brodén's view accurately showed step-offs and gaps following open reduction and internal fixation. Interobserver reliability showed a fair level of agreement for step-offs and excellent agreement for gaps. Intraobserver reliability was only enough for radiographs, not for fluoroscopy.
Level IV, case series.
迄今为止，对于切开复位内固定治疗关节内跟骨骨折后应采用哪种术后影像学检查方法，尚未达成共识。本研究旨在明确 Brodén 位是否足以作为评估后关节面台阶和间隙的术后影像学检查。
6 名观察者在 42 例手术治疗的关节内跟骨骨折患者中评估了 Brodén 位的台阶和间隙大小。这些发现与术后 CT 扫描（金标准）进行比较。使用组内相关系数（ICC）计算并比较了观察者间和观察者内的可靠性。
在足踝专家中，台阶和间隙的准确性约为 75%。经验较少的观察者在透视术中正确识别台阶和间隙的比例约为 62%，在 X 线片上为 48%。术中透视术和术后 X 线片的观察者间可靠性对于台阶均为一般，而对于间隙的观察者间可靠性则为极好。术中透视术的观察者内可靠性一致性低，而术后 X 线片的观察者内可靠性对于台阶具有极好的一致性，对于间隙具有良好的一致性。
我们的结果表明，尤其是对于经验更丰富的足踝外科医生，在大多数骨折中，Brodén 位能够准确显示切开复位内固定术后的台阶和间隙。观察者间可靠性对于台阶具有一般的一致性，对于间隙具有极好的一致性。观察者内可靠性仅足以用于 X 线片，而不能用于透视术。
IV 级，病例系列。
