“Joint-Elevation” Calcaneus Fracture: A Rare Variant of the Intra-Articular Calcaneus Fracture-Dislocation

Timothy J. Miller
John Y. Kwon

Orthopaedic Foot and Ankle Fellow, Massachusetts General Hospital, Boston, Massachusetts (TJM)
Institute for Foot and Ankle Reconstruction at Mercy, Mercy Medical Center, Baltimore, Maryland (JYK)

Summary

Dr. Timothy Miller and Dr. John Y. Kwon discovered a rare variant that of the calcaneus fracture, known as "joint elevation", which results in a portion of the posterior facet above the posterior talus, appearing striking similar to the Bohler's angle.

This study determines that surgeons should be aware of this joint elevated calcaneus fracture in patient diagnosis and care.

Abstract

Calcaneus fractures are the most commonly fractured tarsal bone with approximately 75% being intra-articular in nature. Böhler’s angle has been found to be reliable and prognostic, and it has been used as a proxy for joint depression and articular involvement. It often guides the need for advanced imaging and/or operative intervention. We describe a rare variant of intra-articular calcaneus fracture-dislocation that results in elevation of a portion of the posterior facet above the posterior talus and a seemingly normal or increased Böhler’s angle, which we call the “joint-elevation” calcaneus fracture. Orthopaedic surgeons should be aware of this previously undescribed variant in order to avoid inappropriate treatment or misdiagnosis.

Level of Evidence: Therapeutic Level IV: Case Series