• de Muinck Keizer R J O RJO http://orcid.org/0000-0001-7370-7785 Trauma Unit, G4-137, Department of Surgery, Academic Medical Center, PO-box 22660, 110, Beerekamp M S H MSH Trauma Unit, G4-137, Department of Surgery, Academic Medical Center, PO-box 22660, 1100 DD, Amsterdam, The Netherlands., D T Ubbink, Beenen L F M LFM Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands., T Schepers, and J C Goslings.
• Trauma Unit, G4-137, Department of Surgery, Academic Medical Center, PO-box 22660, 1100 DD, Amsterdam, The Netherlands. rjodemuinckkeizer@amc.nl.
• Arch Orthop Trauma Surg. 2017 Sep 1; 137 (9): 1261-1267.

IntroductionUp to date, there is a lack of reliable protocols that systematically evaluate the quality of reduction and hardware positioning of surgically treated calcaneal fractures. Based on international consensus, we previously introduced a 23-item scoring protocol evaluating the reduction and hardware positioning in these fractures based on postoperative computed tomography. The current study is a reliability analysis of the described scoring protocol.MethodsThree raters independently and systematically evaluated anonymized postoperative CT scans of 102 surgically treated calcaneal fractures. A selection of 25 patients was scored twice by all individual raters to calculate intra-rater reliability. The scoring protocol consisted of 23 items addressing quality of reduction and hardware positioning. Each of these four-option questions was answered as: 'optimal', 'suboptimal (but not needing revision)', 'not acceptable (needing revision)' or 'not judgeable'. We used intraclass correlation coefficients (ICC's) to calculate inter- and intra-rater reliability.ResultsInter-rater reliability of the overall 23-item protocol was good (ICC 0.66, 95% CI 0.64-0.69). Individual items that scored an inter-rater ICC ≥0.60 included evaluation of the calcaneocuboid joint, the posterior talocalcaneal joint, the anterior talocalcaneal joint, the position of the plate and sustentaculum screws and screws protruding the tuber and medial wall. The intra-rater reliability for the overall protocol was good for all three individual raters with ICC's between 0.60 and 0.70.ConclusionOur scoring protocol for the radiological evaluation of operatively treated calcaneal fractures is reliable in terms of inter- and intra-rater reliability.

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