Correlation of bohler’s angle and role of bone graft in the functional outcome of displaced intra-articular calcaneal fractures

Abstract

Background: Calcaneum is the most common tarsal bone fractured. The treatment is difficult and rehabilitation can be time-consuming, and still the outcome is highly unpredictable. This makes calcaneal fractures a huge socio-economic burden to society. This made us search for a variable, like Bohler's angle, which we could relate with functional outcome in patients with intra articular calcaneal fractures. Material and method: 42 patients who had intra-articular fracture of a calcaneum were selected. All the patients were investigated preoperatively with x-rays and CT scanning. The Bohler's angle was calculated on the lateral radiograph manually with the help of goniometer and a record was prepared for future references. Randomization was done and all patients were managed with open reduction and internal fixation with plate with or without bone graft. Bohler's angle was measured post operatively and at follow up on 4 weeks, 6 weeks, 8 weeks and after 3 and 6 months and 1 year. Assessment of the patient with Functional recovery was done with American orthopaedic foot and ankle score (AOFAS) minimum 6 months after injury. Result: Our study of 42 calcaneal fractures confirms that there is statistically significant difference between the functional outcome of patients regarding correction of the Bohler's angle obtained during surgery. When Bohler's angle is restored within normal limits, in an operated calcaneus fractures, fewer complications and statistically significant better results were observed. We also confirmed that autologous bone graft is beneficial in achieving and maintaining restoration of calcaneal height and anatomic reduction. Conclusion: In view of the excellent results obtained with restoration of Bohler's angle, we advocate the use of Bohler's angle as a key to achieve excellent result in displaced calcaneal fracture and also use of autologous bone graft in achieving and maintaining normal Bohler's angle.

The determination of the Boehler tuber joint angle and Gissane critical angle in Turkish population according to age and gender

“…Calcaneus fracture is common (slipping from stairways and motor vehicle accidents). 5,7,8 Radiological measurement of the BA and the GA of the calcaneus plays major role in calcaneal fracture diagnosis, management and assessment of prognosis, intra operative reduction and fixation. 5 The BA is called as calcaneal angle, tuber joint angle or salient angle.…”

“…6,7 The mainly reasons of calcaneal fractures are fall from height and motor vehicle accidents. 7,8 This type fractures occur are commonly due to high velocity trauma. 9 The calcaneal fractures are the most disabling fractures and common between 21 to 45 years.…”

“…7 So, the treatment of calcaneus fractures are difficult and time consuming and this makes Calcaneal fractures a huge socioeconomic burden to society. 8 The Boehler angle (BA) is a parameter used in evaluate the integrity of the calcaneus. Also, BA is the one of the calcaneal angles and a very useful parameter in evaluation and diagnosis of calcaneal fractures.…”

Functional outcome in non-operative management of displaced Intra-articular calcaneal fractures (Diacf’s)

“…Pawar et al (2018) [19] ORIF with bone grafting 21 82.61 ORIF without grafting 21 79.9 Prabhakar et al (2018) [20] ORIF…”