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

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. © 2013 Springer-Verlag Berlin Heidelberg.