Lorenz Böhler

Biography

• Born on January 15, 1885 in Wolfurt, Vorarlberg, Austria
• 1905–1911 – Studied medicine at the University of Vienna; awarded the degree of Doctor of Medicine in 1911.
• 1911–1914 – Held junior surgical and medical appointments in Vienna, Ragusa, Bozen and Tetschen. Attended the International Surgical Congress in New York in 1914 and subsequently spent several months at the Mayo Clinic in Rochester, Minnesota.
• 1914–1918 – Served as a surgeon with the Tyrolean Kaiserjäger during the First World War. In 1916 assumed command of a reserve military hospital at Bozen and developed a specialist service for gunshot fractures and joint injuries, introducing standardised treatment, radiographic follow-up, detailed documentation and outcome analysis.
• 1924–1925 – Served as chief surgeon at the Kaiser Franz Josef Jubilee Hospital in Brixen. Left the now-Italian South Tyrol and moved to Vienna.
• 1925 – Appointed medical director of the specialised AUVA Unfallkrankenhaus in Webergasse, Vienna, which opened on December 1.
• 1929 – Presented Behandlung der Fersenbeinbrüche at the 53rd meeting of the German Society of Surgery describing the radiographic Gelenk-Tuberwinkel or “tuber-joint angle” subsequently known as Böhler angle.
• 1930 – Completed his habilitation in surgery at the University of Vienna
• 1938–1940 – Joined the NSDAP and other National Socialist organisations and became a supporting member of the SS. His political activities and the 1939 Vienna medical faculty letter are discussed separately below.
• 1941–1945 – Served as a consulting surgeon to the Wehrmacht and directed a specialist military service for gunshot fractures and joint injuries at the Rudolfspital in Vienna.
• 1954 – Awarded the title of ordentlicher Universitätsprofessor
• 1963 – Retired after 38 years as director of the Vienna Unfallkrankenhaus.
• 1972 – The new Unfallkrankenhaus Wien Lorenz Böhler was formally opened on November 9.
• Died on January 20, 1973 in Vienna, ten weeks after the opening of the hospital bearing his name. Buried in Döbling Cemetery.

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Medical Eponyms

Böhler angle (1929)

The Böhler angle, originally termed the Gelenk-Tuberwinkel or joint–tuberosity angle, is measured on a lateral calcaneal radiograph. It is formed by a line from the posterior calcaneal tuberosity to the highest point of the posterior articular facet and a second line from the posterior facet to the anterior calcaneal process. The angle provides a two-dimensional estimate of calcaneal height and posterior-facet depression; following a compression fracture it may become reduced, flattened or reversed.

1929 – Lorenz Böhler (1885-1973) presented Behandlung der Fersenbeinbrüche at the 53rd meeting of the German Society of Surgery on April 6, 1929. The paper was published in Archiv für klinische Chirurgie later that year.

1930–1931 – Böhler delivered an invited lecture on calcaneal fractures at the American Orthopaedic Association meeting in Chatham, Massachusetts, in June 1930. The expanded English-language paper, Diagnosis, pathology and treatment of fractures of the os calcis, was published in 1931.

Normally there exists, between the upper contour of the tuberosity of the os calcis and the line uniting the highest point of the anterior process with the highest point of the posterior articular surface, an angle of thirty to thirty-five degrees. This angle I have named the “tuber-joint angle“. In fractures of the os calcis this angle becomes smaller, straight, or even reversed

Böhler 1931

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Key contributions

Systematic principles of fracture treatment

Böhler’s principal clinical contribution was a reproducible system for managing fractures. Its foundations developed during the First World War, particularly after he assumed control of the military hospital at Bozen in 1916 and reorganised it as a specialist service for gunshot fractures and joint injuries.

Böhler transformed fracture management into a systematic programme of diagnosis, reduction, immobilisation, radiographic control, exercise and follow-up. The injured region was stabilised while unaffected joints and muscles remained active, with success judged by restoration of function rather than fracture union alone.

Although strongly associated with non-operative treatment, he adopted operative methods when he considered their mechanical and clinical advantages established. His later advocacy of Gerhard Küntscher’s intramedullary nail illustrates this selective rather than dogmatic approach.

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The Vienna Unfallkrankenhaus and organised trauma care

Böhler’s wartime experience convinced him that outcomes improved when injured patients were concentrated in a dedicated service staffed by clinicians experienced in fracture and trauma management.

After the war, Böhler persuaded the Austrian workers’ compensation authority that specialised treatment of occupational injuries could improve clinical results while reducing permanent disability and compensation costs.

The AUVA Unfallkrankenhaus opened in the Webergasse, Vienna, on December 1, 1925, with Böhler as medical director. He remained in that role until his retirement in 1963. The hospital integrated acute trauma treatment, radiology, fracture wards, operating facilities, rehabilitation, teaching, documentation and follow-up within one institution. It became an influential international model for specialised accident hospitals.

Böhler closely supervised the organisation of care and required adherence to detailed treatment protocols. This discipline attracted criticism from some Viennese surgical contemporaries but also drew increasing numbers of international visitors. His institutional achievement was to demonstrate that trauma surgery could function as a defined clinical service rather than as a miscellaneous component of general surgery.

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Rehabilitation, documentation and functional outcome

Böhler incorporated rehabilitation and outcome measurement into the primary treatment of injury. Movement of unaffected joints, preservation of muscle function and progressive restoration of activity began during immobilisation. Detailed documentation, serial radiographs and long-term follow-up allowed him to assess deformity, disability and return to work, providing a substantial evidence base for fracture care.

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Teaching and the international development of trauma surgery

Böhler disseminated his methods through structured teaching courses and his textbook, Die Technik der Knochenbruchbehandlung, first published in 1929. The book developed from practical instructional material prepared for students and visiting physicians. After established medical publishers rejected it, Böhler initially financed its publication with Viennese bookseller Wilhelm Maudrich.

The original short manual was repeatedly revised and expanded into a multivolume reference work. Its step-by-step instructions, sequential radiographs and extensive illustrations made complex fracture treatment reproducible beyond Böhler’s own institution. It was translated into eight languages and became widely known simply as “der Böhler.”

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Nazi affiliations, wartime service and post-war denazification

Böhler’s medical legacy must be considered alongside his affiliations during National Socialism. He applied for NSDAP membership in 1938, became a supporting member of the SS in 1939 and joined other National Socialist organisations. He also signed a 1939 letter denying racial or religious persecution within the Vienna medical faculty, thereby lending support to the regime’s antisemitic university policies. During the Second World War he served as a consulting surgeon to the Wehrmacht and directed a specialist military fracture service.

Böhler temporarily lost his teaching authorisation during post-war denazification. He maintained that he had joined the Nazi Party under institutional pressure and denied illegal pre-Anschluss membership. His teaching rights were subsequently restored, but the extent to which his affiliations reflected career pragmatism, political accommodation or ideological sympathy remains incompletely resolved.

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Major Publications

• Böhler L. Die Spezialisierung der Frakturbehandlung für die Kriegszeit, eine Frage von grösster volkswirtschaftlicher Bedeutung, Zentralblatt für Chirurgie 1918; 45: 793-795
• Böhler L. Wie schützen wir die Verwundeten vor Amputation und Krüppeltum? Zeitschrift für orthopädische Chirurgie einschließlich der Heilgymnastik und Massage 1924; 45: 244-281
• Böhler L. Behandlung der Fersenbeinbrüche. Arch Klin Chir. 1929;157:723–732.
• Böhler L. Die Technik der Knochenbruchbehandlung, Band I, Band II, Ergänzungsband 1929 [The Treatment Of Fractures Vol I, II, III]
• Böhler L. Wie schützen wir die Verwundeten vor Amputation und Krüppeltum? Zeitschrift für orthopädische Chirurgie 1924; 45: 244-281.
• Böhler L. Diagnosis, pathology and treatment of fractures of the os calcis. J Bone Joint Surg 1931; 13: 75-89 [Böhler angle]
• Böhler L. The Treatment of Fractures. William Wood & Company. 1929 [4e 1936, 5e 1956]
• Böhler L. Wundbehandlung. Zeitschrift für ärztliche Fortbildung. 1941; 38 (22): 545-552.
• Böhler L. Unfallkrankenhäuser, Unfallabteilungen, Unfallkliniken. Archiv für orthopädische und Unfall-Chirurgie 1942; 42(1): 5–23.
• Böhler L. Vorschlag zur Marknagelung nach Küntscher bei frischen Oberschenkelschussbrüchen. Der Chirurgie 1943; 15(1): 8–13.
• Böhler L. Medullary Nailing Of Kuntscher. 1948

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References

Biography

• Bohler J. Lorenz Böhler: in memoriam. J Trauma. 1973; 13(7): 658-659.
• Ehalt W. In memoriam Prof. Dr. Lorenz Böhler. Wien Med Wochenschr. 1973 Mar 24;123(12):198
• Lorenz Böhler, Der Vater der Unfallchirurgie. 15. 1. 1885-20. 1. 1973. Zentralbl Chir. 1985;110(4):193-9.
• Wyklicky H. Lorenz Böhler zum 100. Gerburstag Unfallchirurgie. 1985 Jun;11(3):103-6.
• Kyle RA, Shampo MA. Lorenz Böhler: distinguished traumatologist. Mayo Clin Proc. 1990 May;65(5):708.
• Mostofi SB. Lorenz Böhler. Who’s Who in Orthopedics. Springer. 2005: 30-31
• Markus G. “Vater der Unfallchirurgie”: Wer war Lorenz Böhler? Kurier, 2024

Eponymous terms

• Chen MY, Bohrer SP, Kelley TF. Boehler’s angle: a reappraisal. Ann Emerg Med. 1991 Feb;20(2):122-4.
• Arslan G, Yirgin IK, Tasguzen A. A measuremental approach to calcaneal fractures. Eur J Trauma Emerg Surg. 2014; 40(5): 593-9
• Nawfar SA, Chan KL, Idham HM, Izani IM, Nahulan T. Outcome Determining Factors for displaced Intra-articular Calcaneal Fractures treated operatively. Malays Orthop J. 2015 Nov;9(3):8-16
• Otero JE, Westerlind BO, Tantavisut S, Karam MD, Phisitkul P, Akoh CC, Gao Y, Marsh JL. There is poor reliability of Böhler’s angle and the crucial angle of Gissane in assessing displaced intra-articular calcaneal fractures. Foot Ankle Surg. 2015 Dec;21(4):277-81. 
• De Boer AS, Van Lieshout EMM, Vellekoop L, Den Hartog D, Kleinrensink GJ, Verhofstad MHJ. The Influence of Radiograph Obliquity on Böhler’s and Gissane’s Angles in Calcanei. J Foot Ankle Surg. 2020 Jan-Feb;59(1):44-47. 
• Nooijen LE, Spierings KE, Sanders FRK, Dingemans SA, Halm JA, Schepers T. Determining the Correlation Between Lateral Radiograph Morphology and the Outcome Following Surgically Treated Intra-Articular Calcaneal Fractures. Foot Ankle Spec. 2021 Apr;14(2):105-113.
• Novaes T, Casagrande E, Santos AS, Zharikov Y, Fernandes R, Pires L, Babinski M, Gameiro V. Comparison and agreement analysis of Böhler and Gissane angles on radiographs and CT in dry human calcanei. J Orthop Surg Res. 2026 Jan 30;21(1):160.
• Cadogan M. Eponymythology of foot injuries. LITFL