Related Experiment Video
Updated: Aug 5, 2026
Assessment of Bone Fracture Healing Using Micro-Computed Tomography
Published on: December 9, 2022
Enhancing orthopaedic resident competency in calcaneal fracture evaluation with Sanders classification: A comparative
Mete Özer1, Ece Davutluoğlu2, Yahya Deniz3
1Department of Orthopaedics and Traumatology, Basaksehir Cam and Sakura City Hospital, Istanbul, Türkiye; Department of Anatomy, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Türkiye.
Background:
Interpretation of intra-articular calcaneal fractures using the Sanders classification remains challenging because of complex three-dimensional morphology. This study compared CT, 3D printing, and virtual reality (VR) for Sanders classification.
Methods:
Thirty-three calcaneal fractures were assessed by 25 orthopaedic residents using CT, 3D-printed models, and VR. Interobserver agreement and within-observer cross-modality concordance were analysed using Cohen's kappa (κ) and intraclass correlation coefficients (ICC). Accuracy was compared with a composite reference standard.
Results:
Interobserver agreement was highest with 3D printing (κ = 0.26; ICC = 0.90). CT showed the highest overall classification accuracy (p < 0.001). Agreement and accuracy were not affected by training level or session. VR was the preferred modality (80%).
Conclusions:
3D visualization improved interobserver agreement, whereas CT remained the most accurate modality. VR showed strong perceived educational value. Modality-dependent differences suggest that 3D methods may complement and refine CT-based Sanders classification.
Level:
Level II diagnostic evidence.
