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.