Review Question - QID 329

Figure A shows a displaced intra-articular calcaneus fracture. Studies have found in this fracture pattern a Böhler angle of greater than 0-15° is associated with improved outcomes.

Buckley et al (2002) found that patients with the following preoperative variables have improved outcomes with ORIF vs non-operative treatment: women, non-workers' compensation, younger males (<30), patients with a higher Böhler angle (>0-15°), patients with a lighter workload, and fracture patterns with single, simple displaced intra-articular calcaneal fracture.

Buckley et al (1992) found that anatomic or near anatomic reductions (<2mm stepoff) enhance outcomes while comminuted reductions or fractures without reduction produce long-term outcomes that are less satisfactory.

Bajammal et al investigated intra-articular calcaneus fractures and reported that patients who were NOT receiving Workers' Compensation, were younger (less than twenty-nine years old), had a moderately lower Böhler angle (0 degrees to 14 degrees ), a comminuted fracture, a light workload, or an anatomic reduction or a step-off of < or =2 mm after surgical reduction (p = 0.04) scored significantly higher on the scoring scales after surgery compared with those who were treated nonoperatively.

Illustration A shows the Böhler angle, which is an angle between the following two lines: 1) a line connecting anterior process and highest point on posterior articular surface, 2) a line connecting highest point on posterior articular surface and superior tuberosity. A normal Böhler angle is 20-40°. Flattening of the Böhler angle represents collapse of the posterior facet. Illustration B shows both the critical angle of Gissane (G) and the Boehler angle (B).

Incorrect Answers:
Answer 1. Patients with heavier workloads have worse outcomes with surgery.
Answer 2. Patients with Worker's Compensation claims have worse outcomes with surgery.
Answer 3. A normal angle of Gissane does not necessarily indicate posterior facet depression, and no improvements with surgical treatment have been shown.
Answer 5. A comminuted posterior facet is associated with worse outcomes.