Morphometric Analysis of Calcaneal Angles (Bohler’s and Gissane’s angle) in the North Indian Population

Background: Calcaneal fractures are the most common tarsal bone injuries, accounting for 60–70% of tarsal fractures, and frequently occur due to high-energy trauma such as road traffic accidents and falls from height. These fractures significantly impair mobility and work capacity, particularly among individuals aged 21–45 years. Radiographic assessment using Bohler’s and Gissane’s angles is essential for determining fracture severity and guiding appropriate treatment planning.

Methodology: A study was conducted in the SGT University Hospital Gurugram, Haryana. The study included 100 cases (60M, 40F), with mean age 41.66 ± 17.14 years (Range 15 - 89 years). Ankle lateral radiograph was taken by using CR X-ray machine (Fuji Modality). Lateral ankle radiographs in all the cases were evaluated for the measurement of Bohler’s and Gissane’s angle with the help of experienced Radiologist and Orthopedician.

Result: The mean of Bohler’s angle and Gissane’s angle in the north Indian population were 28.70° (15 - 54°) and 112.18° (100 - 13°) respectively. The mean Bohler’s angle was found highest (30.57 ± 5.88°) in age group with age ranged from 15 - 29 years and lowest (27.44 ± 7.36°) in age group with age ranged from 30 - 44 years whereas Gissane’s angle was found highest (116.56 ± 10.03°) and lowest (109.77 ± 5.54°) in age group with age range of 75 - 89 years and 30 - 44 years respectively. There was no significant Difference in the Bohler’s and Gissane’s angle between males and females.

Conclusion: In the north Indian population, the mean of Gissane’s angle and mean Bohler’s angle was found 28.70 ± 7.24° and 112.18 ± 7.09° respectively. There was no significant Difference in the Bohler’s and Gissane’s angle between genders. 

Calcaneal angle, Bohler’s angle and Gissane’s angle

1. G Arslan, I. K Yirgin, A. tasguzen. A measuremental approach to calcaneal fractures. Eur J Trauma Emerg Surg. (2013). [Google Scholar] [Crossref]

2. H. Zwipp, S. Rammelt, S. Barthel, Fractures of the calcaneus, Der Unfallchirurg 108 (2005) 737. [Google Scholar] [Crossref]

3. Molly AP SJ. Hind foot arthrodesis for management of bone loss following calcaneus fractures and nonunions. Foot and ankle clinics. 2011 Mar; 16(1): 165-79. [Google Scholar] [Crossref]

4. Hollawell S. Wound closure technique for lateral extensile approach to intra- articular calcaneal fractures. Journal of the American Podiatric Medical Association 2008 Sep-Oct; 98(5): 422-5. [Google Scholar] [Crossref]

5. Bohler L. Diagnosis, pathology and treatment of fractures of the os calcis. J Bone Joint Surg Am.1931; 13(1):75-89. [Google Scholar] [Crossref]

6. Gissane W. Discussion on ‘’Fractures of the os calcis’’. Proceedings of the British Orthopaedic Association. J Bone Joint Surg Am. 1947; 29:254-55. [Google Scholar] [Crossref]

7. https://www.ebmconsult.com/articles/critical-angle-gissane-calcaneus-fractures. [Google Scholar] [Crossref]

8. Sonin AH, Boles CA, Roger LF. Skeletal Trauma. In: Grainger RG, Alleson DJ, Adam A, Dixon AK, editors. Diagnostic Radiology. 4th ed. Vol. 3. London, UK: Elsevier Churchill Livingstone; 2001. Pp. 1813. [Google Scholar] [Crossref]

9. Yochum TR, Rowe LJ. Essentials of Skeletal Radiology. 3th ed. Vol 1. Philadelphia: Lippincott Williams and Wilkins; 1996. Pp. 241. [Google Scholar] [Crossref]

10. Parkers JC 2nd: The nonreductive treatment for fractures of the Os calcis. Orthop Clin North Am 1973, 4(1):193-195. [Google Scholar] [Crossref]

11. Leung KS, Chan WS et al. operative treatment of intra-articular fractures of the os calcis-- the role of rigid internal fixation and primary bone grafting: preliminary results. J Ortho Trauma 1989, 3(3):232-240. [Google Scholar] [Crossref]

12. East Wood DM et al. intra-articular fractures of the Calcaneum. Part II: Open reduction and internal fixation by the extended lateral trans-calcaneal approach. J Bone Joint Surg Br 1993, 75(2): 189-195. [Google Scholar] [Crossref]

13. Johnson EE, Gebhardt JS: Surgical management of calcaneal fractures using bilateral incisions and minimal internal fixation. Clin Ortho Relat Res 1993, 290:117-124. [Google Scholar] [Crossref]

14. O’Farrell DA at el. Fracture of the Os calcis: improved results with internal fixation. Injury 1993, 24(4):263-265. [Google Scholar] [Crossref]

15. Vetrivel C. Sengodan at el. Bohler’s and Gissane angles in the Indian population. Journal of Clinical Imaging Science. 2012; 2:77. [Google Scholar] [Crossref]

16. Mishra PK et al. Bohler’s and Critical Angle of Gissane: Morphometry in Adult Indian Population. J Foot Ankle Surg (Asia Pacific) 2021; 8(2):72-75. [Google Scholar] [Crossref]

17. Louro ECS, Faleiro TB et al. Radiographic study of Bohler and Gissane angles in the Brazilian population. J Foot Ankle. 2020; 14(1):57-61. [Google Scholar] [Crossref]

18. Fahmy Anwar Shoukry et al. evaluation of the normal calcaneal angles in Egyptian population. Alexandria Journal of Medicine (2012) 48, 91-97. [Google Scholar] [Crossref]

19. Rokaya PK et al. Radiographic evaluation of calcaneal angles in the patients presenting to tertiary care center of Nepal. Journal institute of Medicine (2016), 38:2-3. [Google Scholar] [Crossref]

20. Katchy AU et al. morphometric analysis of calcaneal angles in Igbos of South of Nigeria and its clinical implication: A plain X-ray study. Nigeria J Orthop Trauma (2018); 17:64-71. [Google Scholar] [Crossref]

21. Aksel SEYAHI et al. the calcaneal angles in the Turkish population. Anta Orthop Traumatol Turc (2009); 43(5):406-411. [Google Scholar] [Crossref]

22. Rahe Ramachandran, Shailaja Shetty. A Radiological study emphasizing the need to standardize the calcaneal angles of Bohler and Gissane according to the individual’s anthropological parameters. International Journal of Anatomy, Radiology and Surgery (2019), Vol-8(2): AO22-AO25. [Google Scholar] [Crossref]

• Students' Perception Towards Artificial Intelligence in Higher Education in India
• Strategic Leadership and Cybersecurity Readiness in Digitally Transforming Organisations
• Spatial Distribution of Tourism Infrastructure in Awka, Onitsha and Nnewi Urban Areas of Anambra State.
• Emerging Technologies, Education and Skill Development for A Sustainable Blue Economy in Nigeria.
• Quantum Dot–Based Solar Cells: Advancements, Challenges, and Future Prospects