Reliability and Validity of Use of A Smartphone Application For The Measurement of Gissane and Bohler’s Angles in Calcaneal Fractures

Abstract

Objective: Calcaneus is the most often fractured bone of all the tarsal bones in the human skeleton. Initial evaluation of a suspected calcaneal fracture is often assessed with Böhler’s and Gissane’s angles. The aim of this study was to compare the reliability and consistency of measurements of Gissane and Böhler’s angles by using a smartphone application (iPinPoint) and a computer-based program Methods: A total of 41 patients were included. The measurement of fracture angulation was done by two orthopaedic surgeons twice one month apart using iPinPoint and Sectra. The inter- and intraobserver reliability was measured using intraclass correlation coefficients (ICCs). The intraobserver variabilities between the SECTRA and iPinPoint measurements for each participant were evaluated. Interobserver variability was also determined by comparing the results of Böhler’s and Gissane angles among the surgeons Results: The mean difference between the two techniques were 0.9° and 0.4° for Gissane and Böhler’s angles, respectively. The intraobserver reliability of Gissane and Bohler’s angles between smartphone and computer for each observer was very good (ICC=0.938 vs. 0.943, ICC= 0.970 vs 0.979, respectively). Interobserver reliability between two observers for SECTRA and iPinPoint results were very good (ICC=0.955, ICC=0.905 respectively). Conclusion: iPinPoint application can be used for the measurement of Gissane and Bohler’s angles safely. In addition, there are very good results that support it as a reliable and reproducible tool for SECTRA measurements.

Keywords

• Calcaneus
• fracture
• measurement
• smartphone
• Interobserver reliability
• Interobserver reliability

References

1. 1.Zwipp H, Rammelt S, Barthel S. Kalkaneusfraktur[Fracture of the calcaneus]. Unfallchirurg. 2005Sep;108(9):737-47; quiz 748. German. doi:10.1007/s00113-005-1000-6.
2. 2.Brauer CA, Manns BJ, Ko M, et al. An economicevaluation of operative compared withnonoperative management of displaced intra-articular calcaneal fractures. J Bone Jt Surg Am.2005;87(12):2741–9.
3. 3.Court-Brown CM, Caesar B. Epidemiology of adultfractures: a review. Injury. 2006;37(8):691–7.
4. 4.Mitchell MJ, McKinley JC, Robinson CM. Theepidemiology of calcaneal fractures. Foot (Edinb).2009 Dec;19(4):197-200. doi:10.1016/j.foot.2009.05.001. PMID: 20307476.
5. 5.Buckley R, Tough S, McCormack R, et al. Operativecompared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective,randomized, controlled multicenter trial. J Bone JtSurg Am. 2002;84-A (10):1733–44.
6. 6.Van Tetering EA, Buckley RE. Functional outcome(SF-36) of patients with displaced calcanealfractures compared to SF-36 normative data. FootAnkle Int. 2004;25(10):733–8.
7. 7.Westphal T, Piatek S, Halm JP, et al. Outcome ofsurgically treated intraarticular calcaneus fractures– SF-36 compared with AOFAS and MFS. Acta Orthop Scand. 2004;75(6):750–5.
8. 8.Sengodan VC, Amruth KH, Karthikeyan. Bohler'sand Gissane Angles in the Indian Population. J ClinImaging Sci. 2012; 2:77. doi: 10.4103/2156-7514.104310. Epub 2012 Dec 4. PMID: 23393633; PMCID: PMC3551522.

9. 9.Shoukry FA, Aref YK, Sabry AAE. Evaluation of thenormal calcaneal angles in Egyptian population.Alexandria Journal of Medicine 2012;48(2):91-97
10. 10.Franko OI. Smartphone apps for orthopaedicsurgeons. Clin Orthop Relat Res. 2011; 469:2042–2048.
11. 11.Shaw M, Adam CJ, Izatt MT, et al. Use of theiPhone for Cobb angle measurement in scoliosis. EurSpine J 2012; 21:1062–8.
12. 12.Jacquot F, Charpentier A, Khelifi S, et al.Measuring the Cobb angle with the iPhone inkyphoses: a reliability study. Int Orthop 2012;36:1655–60.
13. 13.Ege T, Kose O, Koca K, et al. Use of the iPhone forradiographic evaluation of hallux valgus. SkeletalRadiol 2013; 42:269–73.
14. 14.Walter R, Kosy JD, Cove R. Inter- and intra-observer reliability of a smartphone application formeasuring hallux valgus angles. Foot Ankle Surg2013; 19:18–21.
15. 15.Ketenci IE, Yanık HS. Use of a SmartphoneApplication for Fracture Angulation Measurement.The Medical Journal of Haydarpaşa NumuneTraining and Research Hospital. 2019;59(1):50-3.
16. 16.Shrout PE, Fleiss JL. Intraclass correlations: usesin assessing rater reliability. Psychol Bull. 1979Mar;86(2):420-8. doi: 10.1037//0033-2909.86.2.420. PMID: 18839484.