The reliability and variation of measurements of the os calcis angles in children

Clint, S; Morris, Tim P.; Shaw, Olivia Malaga; Oddy, Michael; Rudge, Ben; Barry, Margaret J.

doi:10.1302/0301-620x.92b4.22565

Cited by 25 publications

(17 citation statements)

References 18 publications

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“…This may explain the few cases in which the Böhler's angle at followup was higher than the initial angle at trauma. Little is known about the interobserver agreement in the measurement of Böhler's angle in calcaneal fractures; it is, however, high in the non-fractured population [21,22]. Interobserver bias for the measurements of Böhler's angle was minimized as much as possible; three observers performed the measurements independently, and any discrepancies in excess of 5°w ere settled by consensus between all three observers.…”

Section: Discussionmentioning

confidence: 99%

The fate of Böhler’s angle in conservatively-treated displaced intra-articular calcaneal fractures

Bakker

Halm

Lieshout

et al. 2012

International Orthopaedics (SICOT)

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Purpose Although the predictive value of Böhler's angle on outcome remains subject of debate, the initial angle at the time of trauma still guides treatment. Changes in Böhler's angle during follow-up are frequently reported following surgical treatment of displaced intra-articular calcaneal fractures (DIACF). The aim of the present study was to determine the changes in Böhler's angle as a measure of secondary fracture displacement following conservative management of DIACF. Methods Thirty-eight patients with a total of 44 displaced intra-articular calcaneal fractures treated conservatively with a minimum of two lateral radiographs during follow-up were analysed. Böhler's angle at different follow-up times was measured by three observers. The change in angle was compared with the angle at trauma, and influence of trauma mechanism and common calcaneal fracture classifications were determined. Results The results showed a significant decline over time of the Böhler's angle in conservatively-treated patients of more than 11°on average at a mean follow-up of 29.2 weeks. This decrease was not related to gender, the initial angle, or the Essex-Lopresti or Sanders classification. A statistically significantly higher decrease was detected in high energetic trauma compared with low energetic trauma. Conclusion The conservative treatment of displaced intraarticular calcaneal fractures is still a viable option, yet a significant secondary displacement in time should be taken into account, as reflected in a decrease of Böhler's angle of 11°up to one year following trauma.

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Section: Discussionmentioning

confidence: 99%

The fate of Böhler’s angle in conservatively-treated displaced intra-articular calcaneal fractures

Bakker

Halm

Lieshout

et al. 2012

International Orthopaedics (SICOT)

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“…Occasionally, acute fracture of the apophysis is described and should be treated with suture 48 . This is different from osteochondrosis of the calcaneal apophysis (Sever's disease), which is secondary to an inflammatory or overload process 45 …”

Section: Calcaneal Fracturesmentioning

confidence: 99%

“…As these lesions are still often underestimated, additional computed tomography exams are useful for correct diagnosis and appropriate surgical planning 20, 29, 48…”

Section: Chopart and Lisfranc Fracture-dislocationsmentioning

confidence: 99%

Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment

Rammelt

Godoy‐Santos

Schneiders

et al. 2016

Revista Brasileira de Ortopedia (English Edition)

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Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, three-dimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.

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“…In contrast to the Böhler angle, the low inter- and intraobserver reliabilities of the Gissane angle should also be considered. 10 As an outcome evaluation of calcaneal fracture, Gougoulias et al 15 referred to the Böhler angle, Gissane angle, subtalar joint congruity, calcaneal height and length, and calcaneal width/subfibular impingement, but it was difficult to say that an appropriate consensus was reached in detail. In this study, the parameters of the reduction quality were set by referring to all these reports and adjusted, but further studies are needed in this regard.…”

Section: Discussionmentioning

confidence: 99%

Learning Curve for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fracture by Extensile Lateral Approach Using the Cumulative Summation Control Chart

2019

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Background: Open reduction and internal fixation (ORIF) of displaced intra-articular calcaneal fracture (DIACF) by extensile lateral approach is widely used but is technically challenging. In this study, the learning curve for ORIF of DIACF by extensile lateral approach was investigated. Methods: Between March 2014 and July 2018, 45 cases consisting of 40 patients underwent operative treatment for DIACF by the extensile lateral approach performed in all instances by a single surgeon. A moving average and cumulative summation control chart (CUSUM) were used for learning curve analyses. Operative failure was defined when at least 1 of the following parameters were unsatisfactory: reduction of Gissane angle and Böhler angle, posterior facet congruency, calcaneal width, subfibular impingement, axial alignment, or calcaneocuboid joint congruency. Results: The mean operating time was 117.4 minutes. Regarding the quality of reduction, the mean preoperative sum of the 7 parameters was 5.1 and improved to 0.6 postoperatively. The CUSUM for operative success peaked in the 20th case. The CUSUM and moving average graphics of operating time peaked at the 9th case and registered nadirs at the 34th case, with slight ascent and decent. The operating time for 20 cases in phase 1 (1-20) and for 25 cases in phase 2 (21-45) of the learning curve did not differ significantly. There was no statistical difference in the severity of fracture pattern. By comparison, in phase 2, patients showed a significantly better postoperative reduction quality. Conclusion: As indicated by multidimensional statistical analyses, primary technical competence in improving the reduction quality of DIACF was achieved after the initial learning period with 20 cases. After the learning curve for ORIF of DIACF, a better reduction quality in the sum of reduction parameters was observed. Level of Evidence: Level III, comparative series.

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The reliability and variation of measurements of the os calcis angles in children

Cited by 25 publications

References 18 publications

The fate of Böhler’s angle in conservatively-treated displaced intra-articular calcaneal fractures

The fate of Böhler’s angle in conservatively-treated displaced intra-articular calcaneal fractures

Foot and ankle fractures during childhood: review of the literature and scientific evidence for appropriate treatment

Learning Curve for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fracture by Extensile Lateral Approach Using the Cumulative Summation Control Chart

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