SLR - March 2013 - Wallace
Reference: Boyle et. al.: The pediatric Bohler’s angle and crucial angle of Gissane: a case series. Journal of Orthopaedic Surgery and Research 2011 6:2.
Scientific Literature Review
Reviewed by: Wendell D. Wallace, DPM
Residency Program: Saint Vincent Hospital, Worcester, MA
Podiatric Relevance:
Bohler’s angle and Gissane’s angle are commonly used to assess patients with calcaneal fractures. The adult values of these angles are well known. However, the normal pediatric values have not yet been established. This study sought to investigate and establish the normal pediatric values of Bohler’s angle and Gissane’s angle.
Methods:
The authors measured Bohler’s angle and Gissane’s angle using normal plain radiographs from patients ranging in age from birth to 14 years of age. Radiographs were requested from the emergency department at their respective hospitals over a five year period from July 2003 to June 2008. The films were retrospectively studied. Patients with plain radiographs showing traumatic, infective or neoplastic abnormalities, or not displaying a full lateral view of the calcaneus were excluded from the study. This left 763 patients with normal plain lateral radiographs of the ankle and calcaneus as reported by the reading radiologist. A comparison group consisting of a consecutive series of 100 plain ankle radiographs displaying a full lateral view of the calcaneus in patients aged 30 years to 70 years of age were used that had been reported as normal by the reading radiologist.
Results:
The mean Bohler’s angle in the pediatric study group was 35.2 degrees with a range of 14.3 – 58.1 degrees. The mean Gissane angle in the pediatric group was 111.3 with a range of 90.1 to 147 degrees. The adult comparison group had a Bohler’s angle mean of 39.2 with a range of 26.2 to 54.9 degrees, while the angle of Gissane’s mean was 111.3 with an average of 97.1 to 132 degrees. The difference between Bohler’s angle and Gissane’s angle when compared to the adult group was statistically significant. Respectively, the p values were as follow: Bohler’s angle (p <0.001) and Gissane’s angle (p = 0.004).
Conclusions:
The study reports on the normal Bohler’s angle and crucial angle of Gissane in a pediatric population. While previous authors have commented on normal age related changes in a number of radiographic angles in the pediatric foot, the authors state that to their knowledge this is the first description of normal values of Bohler’s angle and Gissane’s angle in a pediatric population. The authors hope that these results will be helpful when assessing the severity of calcaneal fractures and management of these fractures in the pediatric population.