Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;40(7):797-802.
doi: 10.1177/1071100719840812. Epub 2019 Apr 8.

Identification of Postoperative Step-Offs and Gaps With Brodén's View Following Open Reduction and Internal Fixation of Calcaneal Fractures

Rosalie C Looijen  1 , Dominique Misselyn  2 , Manouk Backes  1 , Siem A Dingemans  1 , Jens A Halm  1 , Tim Schepers  1
Affiliations

Identification of Postoperative Step-Offs and Gaps With Brodén's View Following Open Reduction and Internal Fixation of Calcaneal Fractures

Rosalie C Looijen et al. Foot Ankle Int. 2019 Jul.

Abstract

Background: 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.

Methods: 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).

Results: 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.

Conclusion: 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 of evidence: Level IV, case series.

Keywords: Brodén’s view; ORIF; calcaneus; fracture; gap; hindfoot; step-off.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.

Figures

Figure 1.
Figure 1.
Assessment of a step-off in height (x) and a gap in width (y) on 2 intraoperative fluoroscopies showing the Brodén’s view with categorical options: (1) 0 to <1 mm: anatomic reduction; (2) 1 to <3 mm: near anatomic reduction; (3) 3 to <5 mm: approximate reduction; (4) >5 mm: failure of reduction; (5) not judgeable.
Figure 2.
Figure 2.
Inter- and intraobserver reliability calculated with intraclass correlation coefficient and subdivided based on guidelines of Cicchetti et al. (ICC, intraclass correlation coefficient; IOF, intraoperative fluoroscopy, POR, postoperative radiograph.) 1Reference 8.
See this image and copyright information in PMC

References

    1. Bakker B, Halm JA, Van Lieshout EM, Schepers T. The fate of Bohler’s angle in conservatively-treated displaced intra-articular calcaneal fractures. Int Orthop. 2012;36(12):2495-2499. - PMC - PubMed
    1. Barrick B, Joyce DA, Werner FW, Iannolo M. Effect of calcaneus fracture gap without step-off on stress distribution across the subtalar joint. Foot Ankle Int. 2017;38(3):298-303. - PubMed
    1. Bedigrew KM, Blair JA, Possley DR, Kirk KL, Hsu JR. Comparison of calcaneal exposure through the extensile lateral and sinus tarsi approaches. Foot Ankle Spec. 2018;11(2):142-147. - PubMed
    1. Biswas D, Bible JE, Bohan M, Simpson AK, Whang PG, Grauer JN. Radiation exposure from musculoskeletal computerized tomographic scans. J Bone Joint Surg Am. 2009;91(8):1882-1889. - PubMed
    1. Broden B. Roentgen examination of the subtaloid joint in fractures of the calcaneus. Acta Radiol. 1949;31(1):85-91. - PubMed