The paediatric Bohler's angle and crucial angle of Gissane: a case series

We measured Bohler's angle and the crucial angle of Gissane using normal plain ankle radiographs of 763 patients from birth to 14 years of age completed over a five year period from July 2003 to June 2008.In our paediatric study group, the mean Bohler's angle was 35.2 degrees and the mean crucial angle of Gissane was 111.3 degrees. In an adult comparison group, the mean Bohler's angle was 39.2 degrees and the mean crucial angle of Gissane was 113.8 degrees. The differences in Bohler's angle and the crucial angle of Gissane between these two groups were statistically significant.We have presented the normal values of Bohler's angle and the crucial angle of Gissane in a paediatric population. These values may provide a useful comparison to assist with the management of the paediatric calcaneal fracture.Bohler's angle and the crucial angle of Gissane are commonly assessed when evaluating patients with calcaneal fractures. Traumatic alteration of these angles can be used as a measure of fracture severity, with one goal of surgical management being restoration of these angles to normal values.Bohler's angle and the crucial angle of Gissane can be measured using plain lateral radiographs of the calcaneus. Bohler's angle is formed by a line drawn from the highest point of the tuberosity to the highest point of the posterior facet and a line drawn from the highest point of the anterior process to the highest point of the posterior facet of the calcaneus (Figure 1A) [1]. The crucial angle of Gissane is seen directly inferior to the lateral process of the talus, formed by a line drawn along the posterior facet of the calcaneus and a line drawn from the anterior process to the sulcus calcaneus (Figure 1B) [1].It is widely accepted that in the adult population, a normal Bohler's angle [2] is 25 to 40 degrees and a normal crucial angle of Gissane [3] is 100 to 130 degrees. The normal value of these two angles in the paediatric population has not, to our knowledge, been establish