The fate of Böhler’s angle in conservatively-treated displaced intra-articular calcaneal fractures

Abstract

Purpose Although the predictive value of Böhler's angle on outcome remains subject of debate, the initial angle at the time of trauma still guides treatment. Changes in Böhler's angle during follow-up are frequently reported following surgical treatment of displaced intra-articular calcaneal fractures (DIACF). The aim of the present study was to determine the changes in Böhler's angle as a measure of secondary fracture displacement following conservative management of DIACF. Methods Thirty-eight patients with a total of 44 displaced intra-articular calcaneal fractures treated conservatively with a minimum of two lateral radiographs during follow-up were analysed. Böhler's angle at different follow-up times was measured by three observers. The change in angle was compared with the angle at trauma, and influence of trauma mechanism and common calcaneal fracture classifications were determined. Results The results showed a significant decline over time of the Böhler's angle in conservatively-treated patients of more than 11°on average at a mean follow-up of 29.2 weeks. This decrease was not related to gender, the initial angle, or the Essex-Lopresti or Sanders classification. A statistically significantly higher decrease was detected in high energetic trauma compared with low energetic trauma. Conclusion The conservative treatment of displaced intraarticular calcaneal fractures is still a viable option, yet a significant secondary displacement in time should be taken into account, as reflected in a decrease of Böhler's angle of 11°up to one year following trauma.

Minimally invasive reduction and fixation of displaced calcaneal fractures: surgical technique and radiographic analysis

“…This correlates with data published on percutaneous reduction with screw fixation [9] and fractures treated with an extensile lateral approach and plate fixation [26]. Bakker et al reported a significant secondary decrease of Böhler's angle of 11°at one year following trauma in conservatively treated fractures [27]. There was only a small increase in the length of the calcaneum by 4.7 mm.…”

Predicting loss of height in surgically treated displaced intra-articular fractures of the calcaneus

“…This cutoff value was chosen following an extensive literature search: in patients treated with ORIF, the highest reported decrease in BA ranged from 6 to 10.4°at 1-year follow-up [6,11,14] and in patients treated conservatively an 11°collapse was detected [3].…”

“…However, the subtalar joint frequently collapses (calcaneal collapse) post-operatively to some extent, which can be seen at radiological follow-up [11,14,24]. Several authors noted a correlation between initial BA and outcome [3,10,15,18,22,24]. The BA at time of admission appears to be a valuable prognosticator for functional longterm results [18].…”

“…Surgical restoration of the BA leads to a better outcome compared with non-operative treatment [15,17]; however, operative overcorrection of a reduced BA should be avoided [18]. Patients treated conservatively have a larger definitive reduction in BA than patients treated operatively [3].…”

Comment on Bakker et al.: change of Böhler’s angle during conservatively-treated displaced intra-articular calcaneal fractures

“…Dear Editor, We have read the article titled "The fate of Böhler's angle in conservatively-treated displaced intra-articular calcaneal fractures" by Bakker et al [1] with great interest and their work should be praised.…”