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Journal of Bone and Joint Surgery - British Volume, Vol 87-B, Issue 2, 205-208.
doi: 10.1302/0301-620X.87B2.15260  
Copyright © 2005 by British Editorial Society of Bone and Joint Surgery
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Sanders classification of fractures of the os calcis

AN ANALYSIS OF INTER- AND INTRA-OBSERVER VARIABILITY

R. Bhattacharya, MRCS (Ed), MRCS(Glas), MSc, Specialist Registrar, Orthopaedics1; U. T. Vassan, FRCS, Staff Grade Surgeon1; P. Finn, MSc, Lecturer in Medical Statistics2; and A. Port, FRCS (Orth), Consultant Orthopaedic Surgeon1

1 James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK.
2 School of Health and Social Care, University of Teesside, Tees Valley, Middlesbrough TS1 3BA, UK.

Correspondence should be sent to Mr R. Bhattacharya at 11 Carham Close, Garden Village, Gosforth, Newcastle upon Tyne NE3 5DX, UK; e-mail: drbhattacharya{at}yahoo.com

Our study was undertaken to assess the inter- and intra-observer variability of the classification system of Sanders for calcaneal fractures. Five consultant orthopaedic surgeons with different subspecialty interests classified CT scans of 28 calcaneal fractures using this classification system. After six months, they reclassified the scans.

Kappa statistics were used to analyse the two groups. The interobserver variability of the classification system was 0.32 (95% confidence interval (CI) 0.26 to 0.38). The subclasses were then combined and assessment of agreement between the general classes as a whole gave a kappa value of 0.33 (95% CI 0.25 to 0.41). The mean kappa value for intra-observer variability of the classification system was 0.42 (95% CI 0.22 to 0.62). When the subclasses were combined, it was 0.45 (95% CI 0.21 to 0.65).

Our results show that, despite its popularity, the classification system of Sanders has only fair agreement among users.




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