Bone graft in the operative treatment of displaced intraarticular calcaneal fractures: is it helpful?
OBJECTIVE
To determine whether autologous bone graft supplementation with open reduction and internal fixation (ORIF) of displaced intraarticular calcaneal fractures (DIACFs) is beneficial in achieving and maintaining restoration of calcaneal height and anatomic reduction of the posterior facet.


METHODS
Prospective historical cohort.


METHODS
Level I trauma center, university hospital.


METHODS
Twenty DIACFs in twenty patients who received ORIF with bone graft supplementation were individually prospectively matched to twenty DIACFs in twenty patients who received only ORIF. Matching criteria for these pairs of patients included age, sex, occupational workload, Essex-Lopresti and Sanders classification, preoperative Böhler's angle, and fixation in the joint.


METHODS
Postoperative computed tomography assessed quality of anatomic reduction. Postoperative and three-month follow-up radiographs assessed Böhler's angle. A validated visual analog scale and Short Form-36 assessed functional outcome at a minimum of two years after surgery.


RESULTS
Twenty-one fractures were (Orthopaedic Trauma Association) 73-C2 (Sanders Type III); fifteen fractures were 73-C1 (Sanders Type II); and four fractures were 73-C3 (Sanders Type IV). In the individually matched pairs of patients, the mean preoperative Böhler's angle was 2 degrees (standard deviation [SD] 14 degrees) for the bone graft group and 1 degree (SD 12 degrees) for the non-bone graft group. Preoperative Böhler's angle differed between individually matched pairs an average of 4 degrees (range 0 to 10 degrees). Böhler's angle increased with surgery a mean of 26 degrees (SD14 degrees) in the bone graft group and 27 degrees (SD 10 degrees) in the non-bone graft group. In the first three months after surgery, a mean decrease in Böhler's angle of 7 degrees (SD 4 degrees) in the bone graft group and 6 degrees (SD 7 degrees) in the non-bone graft group occurred. Statistical analysis of the individually matched pairs found no significant difference between the bone graft and non-bone graft patients regarding the change in Böhler's angle obtained with surgery (p = 0.98) and the change in Böhler's angle in the three months after surgery (p = 0.94). Quality of reduction was similar between groups, with eight matched pairs obtaining an equal reduction, six achieving a better reduction with bone graft, and six achieving a poorer reduction with bone graft. No differences in functional outcome were detected.


CONCLUSIONS
We found no objective radiographic or functional benefit to the use of bone graft supplementation in the operative treatment of DIACFs.
Longino
D
D
Department of Surgery, Foothills Hospital, Calgary, Alberta, Canada.
Buckley
R E
RE
D000293:Adolescent; D000328:Adult; D000843:Ankle Joint / Q000473:pathology; D016025:Bone Transplantation / Q000379:methods*; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011859:Radiography; D014182:Transplantation, Autologous; D016896:Treatment Outcome