Abstract
Reliable evaluation of osseous consolidation after pedal arthrodesis can be difficult,
and the presence or absence of radiographic healing often dictates care. Plain radiographs
remain the mainstay imaging tool owing to their cost, efficiency, and low radiation
exposure. Applying radiographic parameters that can reliably determine osseous healing
is essential. However, currently, no reliable or validated measures are available
to determine osseous union of any joint in the foot or ankle. The purpose of the present
study was to develop a radiographic healing scoring system that would enhance the
diagnostic healing assessment after joint arthrodesis of the foot or ankle. We adapted
several existing scales previously validated for fracture healing in the leg, because
no study has attempted to apply this to a joint fusion model. A total of 150 cases
were evaluated by 6 blinded assessors to test the interrater reliability of the subjective
healing assessment compared with the proposed scoring system. The radiographs were
classified by the postoperative period: ≤4 weeks, 5 to 12 weeks, and >12 weeks. The
initial proposed scale was found to have high interrater reliability but was burdensome.
Using a priori item reduction protocols, a limited 5-item scale further improved the
internal consistency and reduced the burden. The result was excellent interrater reliability
(α = 0.978, standard deviation 0.02, 95% confidence interval 0.96 to 0.99) among all
assessors compared with the reduced reliability (α = 0.752) for subjective arthrodesis
healing. Intrarater reliability was also found to be superior using a test–retest
method. The reliability of this system appeared superior to the subjective assessment
of arthrodesis healing, even in the absence of clinical correlates, after foot arthrodesis.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: April 13, 2018
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
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© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
