{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T22:44:38Z","timestamp":1793573078753,"version":"4.5.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2013,9,24]],"date-time":"2013-09-24T00:00:00Z","timestamp":1379980800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Controversy exits over the role of B\u00f6hler\u2019s angle in assessing the injury severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following internal fixation. This study aims to investigate whether a correlation exists between B\u00f6hler\u2019s angle and the injury severity of displaced calcaneal fractures, and between surgical improvement of B\u00f6hler\u2019s angle and functional outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients treated operatively for unilateral closed displaced intra-articular calcaneal fractures from January 1, 2004 to March 31, 2008 were identified. The B\u00f6hler\u2019s angles of both calcaneus were measured, and the measurement of the uninjured foot was used as its normal control. The difference in the value of B\u00f6hler\u2019s angle measured preoperatively or postoperatively between the angle of the injured foot and that of the contralateral calcaneus were calculated, respectively. The change in B\u00f6hler\u2019s angle by ratio was calculated by dividing the difference value of B\u00f6hler\u2019s angle between bilateral calcaneus by its normal control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot &amp; Ankle Society hindfoot scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>274 patients were included into the study with a mean follow-up duration of 71 months. According to Sanders classification, the fracture pattern included 105 type II, 121 type III and 48 type IV fractures. According to American Orthopaedic Foot &amp; Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 104, 132, 27, and 11 patients, respectively. The preoperative B\u00f6hler\u2019s angle, difference value of B\u00f6hler\u2019s angle between bilateral calcaneus, and change in B\u00f6hler\u2019s angle by ratio each has a significant correlation with Sanders classification (rs=\u22120.178,<jats:italic>P<\/jats:italic>=0.003; rs=\u22120.174,<jats:italic>P<\/jats:italic>=0.004; rs=\u22120.172,<jats:italic>P<\/jats:italic>=0.005, respectively), however, is not correlated with functional outcome individually. The three postoperative measurements were all found to have a significant correlation with American Orthopaedic Foot &amp; Ankle Society hindfoot scores (rs=0.223,<jats:italic>P<\/jats:italic>&lt;0.001; rs=0.224,<jats:italic>P<\/jats:italic>&lt;0.001; rs=0.220,<jats:italic>P<\/jats:italic>&lt;0.001, respectively). However, these correlations were all weak to low.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There was a significant correlation between preoperative B\u00f6hler\u2019s angle and the injury severity of displaced intra-articular calcaneal fractures, but only postoperative B\u00f6hler\u2019s angle parameters were found to have a significant correlation with the functional recovery.<\/jats:p><\/jats:sec>","DOI":"10.1186\/1471-2482-13-40","type":"journal-article","created":{"date-parts":[[2013,9,25]],"date-time":"2013-09-25T01:24:19Z","timestamp":1380072259000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":92,"title":["Bohler\u2019s angle\u2019s role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study"],"prefix":"10.1186","volume":"13","author":[{"given":"Yanling","family":"Su","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingwang","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhanpo","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingze","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2013,9,24]]},"reference":[{"issue":"2","key":"373_CR1","doi-asserted-by":"crossref","first-page":"225","DOI":"10.2106\/00004623-200002000-00009","volume":"82","author":"R Sanders","year":"2000","unstructured":"Sanders R: Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 2000, 82 (2): 225-250.","journal-title":"J Bone Joint Surg Am"},{"issue":"9","key":"373_CR2","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1007\/s00113-005-1000-6","volume":"108","author":"H Zwipp","year":"2005","unstructured":"Zwipp H, Rammelt S, Barthel S: Fracture of the calcaneus. Unfallchirurg. 2005, 108 (9): 737-747. 10.1007\/s00113-005-1000-6. quiz 48","journal-title":"Unfallchirurg"},{"issue":"8","key":"373_CR3","doi-asserted-by":"publisher","first-page":"1854","DOI":"10.2106\/JBJS.H.01475","volume":"91","author":"MQ Potter","year":"2009","unstructured":"Potter MQ, Nunley JA: Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 2009, 91 (8): 1854-1860. 10.2106\/JBJS.H.01475.","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"373_CR4","doi-asserted-by":"publisher","first-page":"271","DOI":"10.4103\/0019-5413.49388","volume":"43","author":"V Rak","year":"2009","unstructured":"Rak V, Ira D, Masek M: Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications. Indian J Orthop. 2009, 43 (3): 271-280. 10.4103\/0019-5413.49388.","journal-title":"Indian J Orthop"},{"issue":"1","key":"373_CR5","first-page":"75","volume":"13","author":"L Bohler","year":"1931","unstructured":"Bohler L: Diagnosis, pathology, and treatment of fractures of the os calcis. J Bone Joint Surg Am. 1931, 13 (1): 75-89.","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"373_CR6","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S0030-5898(20)30516-2","volume":"4","author":"JC Parkes 2nd","year":"1973","unstructured":"Parkes JC: The nonreductive treatment for fractures of the Os calcis. Orthop Clin North Am. 1973, 4 (1): 193-195.","journal-title":"Orthop Clin North Am"},{"issue":"3","key":"373_CR7","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1097\/00005131-198909000-00008","volume":"3","author":"KS Leung","year":"1989","unstructured":"Leung KS, Chan WS, Shen WY, Pak PP, So WS, Leung PC: Operative treatment of intraarticular fractures of the os calcis\u2013the role of rigid internal fixation and primary bone grafting: preliminary results. J Orthop Trauma. 1989, 3 (3): 232-240. 10.1097\/00005131-198909000-00008.","journal-title":"J Orthop Trauma"},{"issue":"2","key":"373_CR8","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1302\/0301-620X.75B2.8444935","volume":"75","author":"DM Eastwood","year":"1993","unstructured":"Eastwood DM, Langkamer VG, Atkins RM: Intra-articular fractures of the calcaneum. Part II: Open reduction and internal fixation by the extended lateral transcalcaneal approach. J Bone Joint Surg Br. 1993, 75 (2): 189-195.","journal-title":"J Bone Joint Surg Br"},{"key":"373_CR9","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/00003086-199305000-00015","volume":"290","author":"EE Johnson","year":"1993","unstructured":"Johnson EE, Gebhardt JS: Surgical management of calcaneal fractures using bilateral incisions and minimal internal fixation. Clin Orthop Relat Res. 1993, 290: 117-124.","journal-title":"Clin Orthop Relat Res"},{"issue":"4","key":"373_CR10","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/0020-1383(93)90183-7","volume":"24","author":"DA O\u2019Farrell","year":"1993","unstructured":"O\u2019Farrell DA, O\u2019Byrne JM, McCabe JP, Stephens MM: Fractures of the os calcis: improved results with internal fixation. Injury. 1993, 24 (4): 263-265. 10.1016\/0020-1383(93)90183-7.","journal-title":"Injury"},{"issue":"3","key":"373_CR11","doi-asserted-by":"publisher","first-page":"463","DOI":"10.1016\/j.fcl.2005.03.002","volume":"10","author":"JD Maskill","year":"2005","unstructured":"Maskill JD, Bohay DR, Anderson JG: Calcaneus fractures: a review article. Foot Ankle Clin. 2005, 10 (3): 463-489. 10.1016\/j.fcl.2005.03.002. vi","journal-title":"Foot Ankle Clin"},{"issue":"6","key":"373_CR12","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1177\/1938640010374121","volume":"3","author":"CF Hyer","year":"2010","unstructured":"Hyer CF, Atway S, Berlet GC, Lee TH: Early weight bearing of calcaneal fractures fixated with locked plates: a radiographic review. Foot Ankle Spec. 2010, 3 (6): 320-323. 10.1177\/1938640010374121.","journal-title":"Foot Ankle Spec"},{"issue":"8","key":"373_CR13","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1097\/00005131-199911000-00007","volume":"13","author":"C Loucks","year":"1999","unstructured":"Loucks C, Buckley R: Bohler\u2019s angle: correlation with outcome in displaced intra-articular calcaneal fractures. J Orthop Trauma. 1999, 13 (8): 554-558. 10.1097\/00005131-199911000-00007.","journal-title":"J Orthop Trauma"},{"issue":"7","key":"373_CR14","doi-asserted-by":"publisher","first-page":"848","DOI":"10.1016\/j.injury.2007.01.003","volume":"38","author":"T Ibrahim","year":"2007","unstructured":"Ibrahim T, Rowsell M, Rennie W, Brown AR, Taylor GJ, Gregg PJ: Displaced intra-articular calcaneal fractures: 15-year follow-up of a randomised controlled trial of conservative versus operative treatment. Injury. 2007, 38 (7): 848-855. 10.1016\/j.injury.2007.01.003.","journal-title":"Injury"},{"issue":"6","key":"373_CR15","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.1097\/TA.0b013e3181e16150","volume":"69","author":"Q Wang","year":"2010","unstructured":"Wang Q, Chen W, Su Y, Pan J, Zhang Q, Peng A, Wu X, Wang P, Zhang Y: Minimally invasive treatment of calcaneal fracture by percutaneous leverage, anatomical plate, and compression bolts\u2013the clinical evaluation of cohort of 156 patients. J Trauma. 2010, 69 (6): 1515-1522. 10.1097\/TA.0b013e3181e16150.","journal-title":"J Trauma"},{"issue":"3","key":"373_CR16","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1097\/TA.0b013e318253b5f1","volume":"73","author":"Z Wu","year":"2012","unstructured":"Wu Z, Su Y, Chen W, Zhang Q, Liu Y, Li M, Wang H, Zhang Y: Functional outcome of displaced intra-articular calcaneal fractures: a comparison between open reduction\/internal fixation and a minimally invasive approach featured an anatomical plate and compression bolts. J Trauma Acute Care Surg. 2012, 73 (3): 743-751. 10.1097\/TA.0b013e318253b5f1.","journal-title":"J Trauma Acute Care Surg"},{"issue":"5","key":"373_CR17","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1007\/s00264-007-0385-y","volume":"32","author":"T Schepers","year":"2008","unstructured":"Schepers T, van Lieshout EM, van Ginhoven TM, Heetveld MJ, Patka P: Current concepts in the treatment of intra-articular calcaneal fractures: results of a nationwide survey. Int Orthop. 2008, 32 (5): 711-715. 10.1007\/s00264-007-0385-y.","journal-title":"Int Orthop"},{"key":"373_CR18","doi-asserted-by":"publisher","DOI":"10.1201\/9780203496909","volume-title":"Statistical Modeling and Analysis for Database Marketing: Effective Techniques for Mining Big Data","author":"B Ratner","year":"2003","unstructured":"Ratner B: Statistical Modeling and Analysis for Database Marketing: Effective Techniques for Mining Big Data. 2003, New York: Taylor & Francis"},{"issue":"4","key":"373_CR19","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.foot.2009.05.001","volume":"19","author":"MJ Mitchell","year":"2009","unstructured":"Mitchell MJ, McKinley JC, Robinson CM: The epidemiology of calcaneal fractures. Foot (Edinb). 2009, 19 (4): 197-200. 10.1016\/j.foot.2009.05.001.","journal-title":"Foot (Edinb)"},{"issue":"3","key":"373_CR20","doi-asserted-by":"publisher","first-page":"172","DOI":"10.5435\/00124635-200405000-00005","volume":"12","author":"RE Buckley","year":"2004","unstructured":"Buckley RE, Tough S: Displaced intra-articular calcaneal fractures. J Am Acad Orthop Surg. 2004, 12 (3): 172-178.","journal-title":"J Am Acad Orthop Surg"},{"issue":"2","key":"373_CR21","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1097\/00005131-199206000-00014","volume":"6","author":"RE Buckley","year":"1992","unstructured":"Buckley RE, Meek RN: Comparison of open versus closed reduction of intraarticular calcaneal fractures: a matched cohort in workmen. J Orthop Trauma. 1992, 6 (2): 216-222. 10.1097\/00005131-199206000-00014.","journal-title":"J Orthop Trauma"},{"issue":"5","key":"373_CR22","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1177\/107110079401500501","volume":"15","author":"F Hutchinson 3rd","year":"1994","unstructured":"Hutchinson F, Huebner MK: Treatment of os calcis fractures by open reduction and internal fixation. Foot Ankle Int. 1994, 15 (5): 225-232. 10.1177\/107110079401500501.","journal-title":"Foot Ankle Int"},{"issue":"3","key":"373_CR23","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1302\/0301-620X.66B3.6725350","volume":"66","author":"JL Pozo","year":"1984","unstructured":"Pozo JL, Kirwan EO, Jackson AM: The long-term results of conservative management of severely displaced fractures of the calcaneus. J Bone Joint Surg Br. 1984, 66 (3): 386-390.","journal-title":"J Bone Joint Surg Br"},{"issue":"5","key":"373_CR24","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1302\/0301-620X.92B5.23542","volume":"92","author":"D Makki","year":"2010","unstructured":"Makki D, Alnajjar HM, Walkay S, Ramkumar U, Watson AJ, Allen PW: Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. J Bone Joint Surg Br. 2010, 92 (5): 693-700.","journal-title":"J Bone Joint Surg Br"},{"issue":"8","key":"373_CR25","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1302\/0301-620X.86B8.15219","volume":"86","author":"M Paul","year":"2004","unstructured":"Paul M, Peter R, Hoffmeyer P: Fractures of the calcaneum. A review of 70 patients. J Bone Joint Surg Br. 2004, 86 (8): 1142-1145. 10.1302\/0301-620X.86B8.15219.","journal-title":"J Bone Joint Surg Br"},{"issue":"5","key":"373_CR26","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1097\/00005373-199611000-00012","volume":"41","author":"K Kundel","year":"1996","unstructured":"Kundel K, Funk E, Brutscher M, Bickel R: Calcaneal fractures: operative versus nonoperative treatment. J Trauma. 1996, 41 (5): 839-845. 10.1097\/00005373-199611000-00012.","journal-title":"J Trauma"},{"issue":"6","key":"373_CR27","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1302\/0301-620X.75B6.8245085","volume":"75","author":"HV Parmar","year":"1993","unstructured":"Parmar HV, Triffitt PD, Gregg PJ: Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study. J Bone Joint Surg Br. 1993, 75 (6): 932-937.","journal-title":"J Bone Joint Surg Br"},{"issue":"10","key":"373_CR28","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.2106\/00004623-200210000-00001","volume":"84-A","author":"R Buckley","year":"2002","unstructured":"Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R: Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2002, 84-A (10): 1733-1744.","journal-title":"J Bone Joint Surg Am"},{"key":"373_CR29","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1097\/00003086-199305000-00009","volume":"290","author":"E Letournel","year":"1993","unstructured":"Letournel E: Open treatment of acute calcaneal fractures. Clin Orthop Relat Res. 1993, 290: 60-67.","journal-title":"Clin Orthop Relat Res"},{"issue":"6","key":"373_CR30","doi-asserted-by":"publisher","first-page":"1271","DOI":"10.2214\/ajr.158.6.1590122","volume":"158","author":"DL Janzen","year":"1992","unstructured":"Janzen DL, Connell DG, Munk PL, Buckley RE, Meek RN, Schechter MT: Intraarticular fractures of the calcaneus: value of CT findings in determining prognosis. AJR Am J Roentgenol. 1992, 158 (6): 1271-1274. 10.2214\/ajr.158.6.1590122.","journal-title":"AJR Am J Roentgenol"},{"issue":"3","key":"373_CR31","doi-asserted-by":"crossref","first-page":"342","DOI":"10.2106\/00004623-199303000-00005","volume":"75","author":"D Paley","year":"1993","unstructured":"Paley D, Hall H: Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors. J Bone Joint Surg Am. 1993, 75 (3): 342-354.","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"373_CR32","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1007\/s10195-008-0037-z","volume":"10","author":"C Mauffrey","year":"2009","unstructured":"Mauffrey C, Klutts P, Seligson D: The use of circular fine wire frames for the treatment of displaced intra-articular calcaneal fractures. J Orthop Traumatol. 2009, 10 (1): 9-15. 10.1007\/s10195-008-0037-z.","journal-title":"J Orthop Traumatol"},{"issue":"1","key":"373_CR33","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1016\/S0030-5898(05)70202-9","volume":"32","author":"FD Shuler","year":"2001","unstructured":"Shuler FD, Conti SF, Gruen GS, Abidi NA: Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures: does correction of Bohler\u2019s angle alter outcomes?. Orthop Clin North Am. 2001, 32 (1): 187-192. 10.1016\/S0030-5898(05)70202-9. x","journal-title":"Orthop Clin North Am"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2482-13-40.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1471-2482-13-40\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2482-13-40","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1471-2482-13-40.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,6]],"date-time":"2022-03-06T21:16:26Z","timestamp":1646601386000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/1471-2482-13-40"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,9,24]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2013,12]]}},"alternative-id":["373"],"URL":"https:\/\/doi.org\/10.1186\/1471-2482-13-40","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,9,24]]},"assertion":[{"value":"15 February 2013","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 September 2013","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 September 2013","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"40"}}