Can Bohler’s Angle Predict the Functional Results of Intra-Articular Displaced Calcaneal Fractures?

Abstract

Introduction: Intra-articular fractures need to be anatomically reduced. In intra-articular calcaneal fractures, Bohler’s angle can be used as a tool to achieve articular congruity intraoperatively. But a debate exists whether surgical restoration of Bohler’s angle to normal range in calcaneal fractures can ensure good functional outcome. Many studies have found no correlation between Bohler’s angle and the ultimate functional outcome. . Aim: To investigate whether correlation exists between the operative restoration of Bohler’s angle and the functional outcome. Materials and Methods: Forty patients with closed intra-articular displaced calcaneal fracture were studied. The injury was classified according to Sanders classification. Preoperative and postoperative Bohler’s angle was determined from radiographs. The functional outcome was assessed using American Orthopaedic Foot and Ankle Society (AOFAS) hind foot score and Visual Analogue Scale (VAS). Results: Forty patients were enrolled in the study with a follow up period of 12 months. As per Sanders classification, there were 14 Type II, 14 Type III and 12 Type IV fractures. The Bohler’s angle preoperatively did not correlate with functional outcome. Postoperative Bohler’s angle correlated significantly with AOFAS hind foot score and Visual analogue scale. Conclusion: Intraoperative restoration of Bohler’s angle to >18 degrees correlated strongly with the ultimate functional outcome. Therefore, aim of treatment in calcaneal fractures should be restoration of Bohler’s angle to near normal value.