Discussion
Our study has shown that the value of the Boehler’s angle in the adult uninjured Croatian Caucasian population was not significantly related to sex and laterality,
whereas the poor correlation with age was,
indeed,
statistically significant,
yet clinically irrelevant.
The most common causes of the calcaneal bone injury are the fall from height and the axial loading [3].
The radiographic calcaneal angles exhibit a wide range of physiological limits and distributions with regard to different populations.
As an accepted method of fracture displacement evaluation,
the Boehler’s angle has a prognostic value in predicting morbidity associated with calcaneal fractures [1,
4,
5].
It seems a reliable radiographic tool for estimating the degree of the intraarticular calcaneal fractures,
especially if fractures are impacted and not displaced.
In addition,
it is easily and reliably measured using a simple plain lateral foot radiograph which is widely available,
economical,
and exposes the patient to relatively low levels of ionizing radiation,
unlike the computed tomography (CT) scanning of the patient’s contralateral extremity.
In general,
the value of the Boehler's angle does not seem to be correlated with age [6-8],
although Fahmy et al.
[9] similarly found a negative correlation,
though ours was too small to be referred to as clinically relevant.
The value of the Boehler’s angle seemed not to be correlated with sex.
We point out,
however,
that our population consisted of Caucasian individuals only.
Some other populations,
such as Ugandan men and women,
exhibited a significant sex difference [10].
The traditional rule of thumb is to class the value of the Boehler’s angle with the value of the patient’s contralateral extremity.
In our study,
however,
there was no statistically significant difference of the values between the feet.
This is in keeping with the results of similar studies in the pertinent literature available in the English language,
estimating the value of the Boehler’s angle in Turkish,
Indian,
Malawian,
Egyptian,
British and Saudi Arabian population [6-13].
On that account,
our results suggest that in the unilateral calcaneal fractures,
the value of the Bohler's angle of the intact side could be taken as an individual reference value.
Every study has some limitations.
The main limitation of our study was its retrospective nature.
Conclusion
The value of the Bohler’s angle of the uninjured calcanei in the adult Croatian Caucasian population is not correlated with age,
sex or laterality.
We sincerely hope that the results of our study would assist in improving the management of calcaneal fractures in Croatia.