![]() ![]() doi: 10.1016/j.jemermed.2013.04.BMC physicians are leaders in their fields with the most advanced medical technology at their fingertips and working alongside a highly skilled nursing and professional staff. The diagnostic accuracy of Böhler’s angle in fractures of the calcaneus. Isaacs JD, Baba M, Huang P, Symes M, Guzman M, Nandapalan H, et al.In: Adams JG, Barton ED, Collings JL, DeBileux PM, Gisondi MA, Nadel ES, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide.7 th New York, NY: McGraw-Hill 2011:1876-1882. ![]() In: Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Musculoskeletal colloquialisms: how did we come up with these names? Radiographics. Topics:Ĭalcaneus fracture, joint effusion, trauma, Böhler angle, X-ray, orthopedics, ortho. Patients with bilateral calcaneal fractures should have further spine evaluation to exclude associated injuries related to axial loading. 2,3 This patient has bilateral calcaneal fractures, yet the Böhler’s angle is indicative of a fracture only on his left ankle, where there is intraarticular extension into the subtalar joint. This angle varies between individuals therefore it is helpful to have the alternative side as a comparison. 4 Fractures of the calcaneus which do not involve the subtalar joint with associated central body compression may demonstrate a normal Böhler’s angle, as seen in our patient’s right ankle radiograph with an ankle of 36 degrees. 2 If the angle is less than 25 degrees then the interpreter should suspect a fracture (sensitivity 100%, specificity 82%), although a normal Böhler’s angle does not exclude it. The second line is drawn between the superior aspect of the posterior calcaneal tuberosity (point C) and point B. The first line is drawn between the superior aspect of the anterior process of the calcaneus (point A) and the superior edge of the posterior articular facet (point B). 2,3 This is the angle formed by the intersection of two lines demonstrated on a normal lateral ankle radiograph. 1 Calcaneal fractures are best diagnosed with a CT scan or with lateral x-ray by measuring Böhler’s angle. 2 The intraarticular fractures are colloquially referred to as a “Lover’s Fracture” as they have been known to occur in those jumping out of a tall window to escape the wrath of a lover’s spouse. 2,3 There are two broad types of calcaneal fractures: intraarticular and extraarticular. Discussion:Ĭalcaneal fractures occur typically in adults who have undergone significant axial load on their feet secondary to a fall from high height. Of note, the Böhler’s angle in the left x-ray is 16 degrees which is consistent with a fracture (see red annotation showing Böhler’s angle). There is subcutaneous air seen anteriorly to the tibiotalar joint space (green arrow) in addition to a joint effusion. The left ankle lateral radiograph shows a displaced, comminuted fracture of the mid to posterior calcaneus with extension into the subtalar joint posteriorly (purple arrow). The right ankle lateral radiograph shows a comminuted, non-displaced fracture of the posterior calcaneus (red arrow) in addition to fracture fragments along the heel pad margin (blue arrow). He denied any back pain, headache, or loss of consciousness. On arrival, the patient had bilateral foot pain. The patient landed onto his feet bilaterally and then fell backwards onto his buttocks. He was repairing a window when he fell, landing on the ground 12 feet below. 40-year-old male presents to the emergency department after falling off a ladder. ![]()
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