Your patient is a 35yo male who presents to the ER with the complaint of foot pain. You learn that the patient sustained a fall from 10 feet landing upright. On exam you note that the patient has pain over the calcaneous. The X-ray is shown above. Do you notice the abnormality?
Take a look now at an axial view of the calcaneous. Do you see the abnormality now?
It’s pretty obvious from the above X-ray that this patient sustained a calcaneal fracture from the fall. Is there any way you could have easily picked up on this when you first looked at the lateral view?
In fact, there is a measurement that could have been made which can pick up on calcaneal fractures. Anytime you are reviewing an X-ray of a patient with pain over the calcaneous, you should measure Bohler’s angle. An illustration of this angle is below:
As you can see above, in order to measure this angle, a line is drawn from the tuberosity to the most superior part of the posterior facet. Another line is drawn from the most superior part of the facet to the anterior process. Normally the angle created is between 20 and 40 degrees. If the angle is less than 20 degrees, this indicates depressed fracture. If you measure Bohler’s angle in the initial X-ray, you will in fact find that the angle is less than 20 degrees.
Interesting Fact: A calcaneal fracture is also known as Lover’s fracture or Don Juan fracture because a lover may jump from great heights to escape the lover’s spouse.
For those of you wanting to read more about the management of calcaneal fractures, check out the following link: calcaneous fracture management