Radiographs

 

Lateral Radiograph - Most important

• Bohler’s Angle - 20-45 degrees
  • 1st line from most superior portion of posterior aspect of calcaneus to most superior portion of posterior facet
  • 2nd line from most superior portion of posterior facet to anterior process
  • Not indicative of severity, only indicated that there has been a fracture
  • Get bilateral films to compare contralateral value
  • May be subtle fracture, Bohler’s angle lets you know that there has been a change
  • Look for flattening out of this angle
• Gissane’s Angle - 120-145 degrees
  • Get flattening with fracture
  • Angle measuring posterior facet and anterior facet.

 

Axial Radiographs - 2nd Most important x-ray

• Posterior aspect of tuberosity
• Lateral wall blowout
• Relationship of sustentaculum tali to rest of calcaneus and calcaneal tuberosity
  • Often get varus position of tuberosity
• Main body of talus is displaced medially which results in buckling

 

DP View (AP view)

• Anterior aspect of calcaneal fx
• Look at CC joint involvement
• Look for concomitant fractures elsewhere in the foot

 

Broden views

• Good for STJ congruity
• Looking at posterior facet
• Can give an idea of incongruity at posterior facet
• Patient lying supine on table
• Foot internally rotated 45 degrees
• X-ray beam tube head angles 10, 20, 30, and 40 degrees from perpendicular
• Helps you look at entire joint

 

CT Scan

• Best way to see Calcaneal fracture – A must for all Calc fractures.
• Gives 3-D view of what is going on in the calcaneus to know where all of the fragments are
• Coronal view is most important on CT scan; sagittal and lateral
  • Need to have knee flexed 50 degrees, foot 30 degrees, angle gantry at 15 degrees from perpendicular to cephalad to go straight through the foot