Improved Interobserver Reliability of the Sanders Classification in Calcaneal Fractures Using Segmented...

Area of Science:

• Orthopedic Surgery
• Radiology
• Medical Imaging

Background:

• Displaced intraarticular calcaneal fractures present diagnostic challenges.
• The Sanders classification is a standard method for categorizing these fractures.
• Interobserver reliability in fracture classification can impact treatment decisions.

Purpose of the Study:

• To evaluate the added value of 3D prints in improving interobserver reliability for the Sanders classification of calcaneal fractures.
• To compare the diagnostic accuracy of 2D computed tomography (CT) images versus 3D prints.

Main Methods:

• Twenty-four observers (radiologists, trainees, foot surgeons) assessed 11 calcaneal fractures using both 2D CT scans and 3D prints.
• Interobserver reliability was measured using kappa coefficients for different versions of the Sanders classification.
• Classification results were compared against perioperative findings.

Main Results:

• 3D prints consistently showed higher agreement and chance-corrected agreement (kappa values) than 2D views across all classification variations.
• Agreement between perioperative evaluation and 3D prints (88%) was significantly greater than with 2D views (65%).
• The use of 3D prints improved interobserver agreement for calcaneal fracture evaluation, particularly after 'digital disarticulation'.

Conclusions:

• 3D prints substantially enhance the interobserver reliability of the Sanders classification for displaced intraarticular calcaneal fractures.
• Utilizing 3D models offers a more accurate and reliable method for classifying complex calcaneal fractures compared to traditional 2D imaging.
• This improved classification accuracy can potentially lead to better surgical planning and patient outcomes.