There is poor reliability of Böhler's angle and the crucial angle of Gissane in assessing displaced intra-articular calcaneal fractures

Otero, Jesse E.; Westerlind, Brian O.; Tantavisut, Saran; Karam, Matthew D.; Phisitkul, Phinit; Akoh, Craig C.; Gao, Yubo; Marsh, J. Lawrence

doi:10.1016/j.fas.2015.03.001

Cited by 26 publications

(30 citation statements)

References 27 publications

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“…Several published studies support this idea . In contrast, some studies report that BA had poor correlation with prognosis after calcaneal fractures . A 15‐year follow‐up of a randomized controlled trial of calcaneal fracture treatment showed that BA had no relationship with the clinical outcome regardless of whether conservative or operative treatment was followed .…”

Section: Discussionmentioning

confidence: 99%

Natural Value of Böhler's Angle in Normal Chinese Population

Bai

Zhang

et al. 2019

Orthopaedic Surgery

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ObjectiveTo determine the value of Böhler's angle (BA) in a group of Chinese people, analyze possible factors that influence it, and compare BA with that in previous literature.MethodsA total of 143 cases, aged from 4 to 79 years, were enrolled in the study, including 64 males and 79 females (79 left feet and 64 right feet). Radiographs were independently measured by six observers. Age, sex, body side, subtalar joint congruity (STJC), and X‐beam obliquity (TT) were recorded. The database was assessed based on intraobserver agreement, data distribution, the randomness of case selection, and the ratio equality of binomial variables. Then, the normal value of BA was established, as well as the correlation between BA and other parameters.ResultsIn the present study, the interobserver reliability of BA, STJC, and TT was excellent. The BA data revealed a normal distribution, and the randomness of case selection was verified for age, sex, and body side. The ratio of sex and body side was equal. Homogeneity of variance was observed when comparing the value of BA between different groups. The value of BA was 31.6° ± 5.19° (range, 20.08°–47.19°), which was not related to age, sex, body side, and minor X‐ray beam obliquity. BA application was not suitable for individuals younger than 10 years. The mean value of BA in this study was not identical with those in previous reports. This demonstrated that BA varies for different races.ConclusionFor Chinese people, 30° to 33° is recommended as the target value of BA for calcaneal fracture reduction, except in children under 10 years of age.

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Section: Discussionmentioning

confidence: 99%

Natural Value of Böhler's Angle in Normal Chinese Population

Bai

Zhang

et al. 2019

Orthopaedic Surgery

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“…Patients from the trauma level II have in general a less severe injury in comparison to trauma level I patients; while, patients with an open fracture likely meet more complications that might result in an unfavourable outcome. Furthermore, the inter- and intra-observer reliability has been reported limited in several occasions [36][37][38][39][40]; therefore, the correct measurement of this angle is questionable. Therefore, we do not advise to use Böhler's angle for estimating the patientreported outcomes.…”

Section: Discussionmentioning

confidence: 99%

Association of pre-treatment radiographic characteristics of calcaneal fractures on patient-reported outcomes

Alexandridis

Gunning

Olden

et al. 2018

International Orthopaedics (SICOT)

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“…This work found no correlation between prognosis and the corresponding BA [6]. Otero has suggested the need for careful application of the BA in the development of treatment strategies for DIACFs because there is great variability in the accuracy of this angle when measured by different physicians [7]. Additional studies have concluded that based on follow-up assessments of patients with calcaneal fractures, there is no correlation between the initially measured BA in surgical and conservative treatment groups and the nal functional outcome [8].Lee et al suggested that BA was not accurate as a sole reference for intraoperative reduction.…”

Section: Discussionmentioning

confidence: 74%

“…Therefore, surgeons should take into account the other radiographic features in surgery [9].The study of Otero showed that for BA, even given a wide tolerance range, there is frequent disagreement among experienced observers. The authors recommend the use of caution when applying BA, as currently measured to make treatment decisions for DIACFs [7]. Moreover, performing ORIF based on the BA of the contralateral uninjured calcaneus as a template does not guarantee more accurate anatomic reduction or restoration of the pre-injury morphology of the calcanei [10].…”

Section: Discussionmentioning

confidence: 99%

A new reference to evaluate the collapse of the posterior facet in displaced intra-articular calcaneal fractures

Wei

Zhao

Cui

et al. 2020

Preprint

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BackgroundWe proposed a new method to evaluate the height of the posterior articular surface in displaced intra-articular calcaneal fractures (DIACFs) by drawing two lines on the lateral radiograph of hindfoot: one line was drawn from the apex of the posterior facet to the apex of the posterior tuberosity (the apex line), and the other line was drawn from the apex of the anterior process to the posterior process (the anterior posterior process line). The aim of this study was to analyze the relationship between these two lines in normal calcanei and their changes in DIACFs.MethodsLateral radiographs of normal calcanei and DIACFs between January 2018 and February 2020 were collected. We draw two lines on the lateral radiograph, one line was the apex line and the other line was the anterior posterior process line. The value of the angle formed by these two lines was recorded, if these two lines were parallel to each other, the angle was recorded as 0°. if these two lines formed an angle anteriorly this was recorded as positive, and if these two lines formed an angle behind the calcaneum this was recorded as negative.ResultsIn 135 normal calcanei lateral radiographs, the minimum angle was − 8°, and the maximum angle was 6°, with an average angle of -1 ± 3°. In 145 DIACFs, the minimum angle was 6°; the maximum angle was 37°, and the average angle was 17°±6°. The difference between normal calcanei and DIACFs was statistically significant (P༜.001).ConclusionThe relationship between the apex line and the anterior posterior process line on lateral radiograph can evaluate the height of the calcaneal posterior facet simply and accurately. The two lines are approximately parallel or angulated backward in the normal calcanei, in DIACFs, these two lines angulated forward.Level of Evidence: Level III-retrospective comparative study.

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There is poor reliability of Böhler's angle and the crucial angle of Gissane in assessing displaced intra-articular calcaneal fractures

Cited by 26 publications

References 27 publications

Natural Value of Böhler's Angle in Normal Chinese Population

Natural Value of Böhler's Angle in Normal Chinese Population

Association of pre-treatment radiographic characteristics of calcaneal fractures on patient-reported outcomes

A new reference to evaluate the collapse of the posterior facet in displaced intra-articular calcaneal fractures

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