Bohler's angle: Correlation with outcome in displaced intra-articular calcaneal fractures

Objectives: Bohler's tuber joint angle is commonly assessed when evaluating calcaneal fractures. A severe heel fracture will result in a significant decrease or loss of this angle. The purpose of this study was to evaluate the correlation between Bohler's angle and functional outcome in displaced intra-articular calcaneal fractures. Design: Prospective cohort study. Setting: Level I trauma center. Methods: Ninety-five fractures in eighty-eight patients were analyzed for clinical outcome as measured by previously validated visual analogue scale (VAS) and SF-36 Health Survey scores. Radiographic results were measurements of Bohler's angle on plain x-rays. Angles were measured twice by two observers working independently. Results: This prospective randomized cohort study indicates that patients initially presenting with a severely depressed Bohler's angle have a poor two-year outcome regardless of treatment. As well, fractures of lesser initial displacement, as measured by Bohler's angle, had higher functional scores on both VAS and SF-36 scoring scales. Conclusion: In this study, Bohler's angle had significant prognostic value in terms of predicting morbidity. Fractures with a markedly diminished Bohler's angle demonstrated a much poorer two-year outcome regardless of treatment. It would seem that the initial Bohler's angle was highly prognostic, regardless of treatment modality.