Large bone distractor for open reconstruction of articular fractures of the calcaneus

Grala, Paweł; Twardosz, W; Tondel, Wieslaw; Olewicz‐Gawlik, Anna; Hrycaj, Paweł

doi:10.1007/s00264-009-0781-6

Cited by 12 publications

(8 citation statements)

References 22 publications

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“…Surgeons in favor of bone grafting believe that it could stimulate fracture healing, leading to early full weight-bearing; may prevent posttraumatic arthritis; and could increase mechanical strength, thus helping to prevent significant late collapse [ 7 , 8 ]. Those not in favor of bone grafts have stated that the highly vascular calcaneus heals radiographically 4–8 weeks after surgery in the absence of bone grafting [ 9 – 11 ], that internal fixation can adequately support the articular surface, that bone grafting increases the infection rate, blood loss, and postoperative pain [ 12 , 13 ], and that it is also important to consider donor site morbidity and complications involved with harvesting an autograft [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of displaced intra-articular calcaneal fractures: is bone grafting necessary?

Singh

Vinay

2013

J Orthopaed Traumatol

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BackgroundThe aim of this retrospective study was to determine the need for bone grafting in the surgical treatment of displaced intra-articular calcaneal fractures. We reviewed 390 cases of displaced intra-articular calcaneal fractures treated with plate osteosynthesis with or without autologous iliac bone grafting, and compared outcomes and complications related to fracture stabilization.Materials and methodsThree hundred ninety patients with displaced intra-articular calcaneal fractures that were treated with plate osteosynthesis from December 2002 to December 2010 were reviewed. Two hundred two patients (group A) were treated by osteosynthesis with autologous bone grafting, and 188 patients (group B) were treated by osteosynthesis without bone grafting. One hundred eighty-one patients with an AO type 73-C1 fracture (Sanders type II), 182 patients with an AO type 73-C2 fracture (Sanders type III), and 27 patients with an AO type 73-C3 fracture (Sanders type IV) were included in this study. Bohler’s angle, the crucial angle of Gissane, and calcaneal height in the immediate postoperative period and at the 2-year follow-up were compared. Any change in the subtalar joint status was documented and analyzed. The final outcomes of all patients were evaluated by the AOFAS Ankle–Hindfoot Scale and compared in both groups.ResultsThe mean full weight-bearing time in group A (with bone grafting) was significantly lower (median 6.2 months, range 2.8–9.2 months) than that in group B (without bone grafting; median 9.8 months, range 6.8–12.2 months). The immediate-postoperative Bohler’s angle and that at the 2-year follow-up were significantly higher in group A. The loss of Bohler’s angle after 2 years was significantly lower in group A (mean 3.5°; 95 % CI 0.8°–6.2°) than in group B (mean 6.2°; 95 % CI 1.0°–11.2°). The average change in the crucial angle and the average change in calcaneal height were not statistically significant for either group. The infection rate in the bone grafting group was higher, though statistically insignificantly so, than in the nongrafting group (8.3 vs. 6.3 %). No significant difference was found between the groups in terms of the rates of good reduction, postoperative osteoarthritis, and subtalar fusion. Regarding the efficacy outcomes, the mean AOFAS score was lower (mean 76.4 points; 95 % CI 65.8–82.9 points) in group A than in group B (mean, 81.6 points; 95 % CI, 72.3–88.8 points), but this difference was not significant (p > 0.05).ConclusionsBohler’s angle showed improved restoration and the patients returned to full weight-bearing earlier when bone grafting was used in the treatment of intra-articular calcaneal fracture. However, the functional outcomes and complication rates of both groups were similar.

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Section: Introductionmentioning

confidence: 99%

Surgical treatment of displaced intra-articular calcaneal fractures: is bone grafting necessary?

Singh

Vinay

2013

J Orthopaed Traumatol

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“…Orthopedic surgeons who insist on bone grafting believe it will stimulate fracture healing, leading to early full weightbearing, preventing posttraumatic arthritis, and increasing mechanical strength, and, thus, helping to prevent significant late collapse (13). Those who do not prefer bone grafting have suggested that internal fixation can adequately support the articular surface and that autografting could the infection rate, blood loss, postoperative pain, donor site morbidity, and complications (14)(15)(16)(17).…”

mentioning

confidence: 99%

Short-Term Outcomes of Open Reduction and Internal Fixation for Sanders Type III Calcaneal Fractures With and Without Bone Grafts

Cao

et al. 2018

The Journal of Foot and Ankle Surgery

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Calcaneal fractures, often caused by a fall from a height, are the most common injuries encountered by orthopedic surgeons. Currently, open anatomic reduction and internal fixation (ORIF) is considered a valuable treatment of displaced intraarticular fractures of the calcaneus; however, the need for bone grafting in the treatment is still controversial. Therefore, in the present study, we investigated the outcomes of 2 methods (with and without bone grafting) used for the surgical treatment of Sanders type III calcaneal fractures. From January 2013 to September 2015, 57 cases (55 patients) with displaced Sanders type III calcaneal fractures (53 unilateral and 2 bilateral) were enrolled. The patients were divided into 2 groups: group I was treated by ORIF with bone grafting (n = 28) and group II was treated by ORIF without bone grafting (n = 29). The radiologic evaluation included Böhler's angle, Gissane's angle, and the height and width of the calcaneum. In addition, the American Orthopaedic Foot and Ankle Society questionnaires and visual analog scale were completed by the patients. During the follow-up period, no differences were found in the outcome measures (Böhler's angle, p = .447; Gissane's angle, p = .599; calcaneal height, p = .065; calcaneal width p = .077; and American Orthopaedic Foot and Ankle Society questionnaires, p = .282) with or without bone grafting. The only difference between the 2 groups was the occurrence of postoperative pain (p = .024 and p = ≤ .05), which was greater in the patients who had undergone bone grafting. We have provided evidence that bone grafting with internal fixation in the treatment of intraarticular calcaneal fractures failed to improve the restoration of Böhler's angle or Gissane's angle. No statistically significant difference was found in the short-term outcomes between the 2 methods used for the surgical treatment of Sanders type III calcaneal fractures.

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“…The meta-analysis by Yang et al showed a mean AOFAS score in patients treated without bone graft to be 80.5 while the current study had a mean score of 81.7% [6] . [12] 38.8% 36.7% 13.2% 11.3% Grala et al (2009) [27] 26.2% 66.7% 0 7.1% Makki et al (2010) [15] 38.3% 36.2% 6.3% 19.2% Current study 22.2% 61.1% 16.7% 0…”

Section: Aofas Scorementioning

confidence: 98%

Change in Bohler and Gissane angles following open reduction and internal fixation without bone grafting for closed sanders type 2 and 3 calcaneal fractures

Bansal¹,

Kohli²,

Aggarwal³

et al. 2020

Int. J. Orthop. Sci.

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Background: Use of bone graft or bone graft substitutes during open reduction and internal fixation of the fractures of the calcaneum is controversial. The present study was an endeavor to evaluate the postoperative change in Bohler and Gissane angles after open reduction and internal fixation without bone grafting of Sanders type 2 & 3 fractures of the calcaneum. Method: 22 cases of closed Sanders type 2 and 3 fracture of the calcaneum were operated by open reduction and internal fixation with calcaneal locking plates without bone grafting. The change in Bohler and Gissane angles from immediate post-operative period to a follow up of 3 and 6 months was measured. AOFAS score was evaluated at 6 months follow up. Results: Out of 22 cases 3 were lost to follow up in the initial 3 months and 1 was lost to follow up after 3 months. A statistically significant change in Bohler and Gissane angles from preoperative to postoperative period was found the change in Bohler and Gissane angle from immediate post-operative period to 3 months follow up was not statistically significant. The change in Bohler and Gissane angle from immediate post-operative period to 6 months follow up was also not statistically significant. At 6month follow-up, mean AOFAS score of 18 cases was 81.7 (range 58-98). 4 patients had excellent result, 11 had good result and 3 patients had fair result and no patient had poor result. The average AOFAS score of 18 cases was 81.7 (range 58-98) at 6-month follow-up. 4 patients had excellent result, 11 had good result and 3 patients had fair result and none had poor result. Conclusion:The present study had a low wound complication rate, good functional score, absence of bone graft donor site morbidity and allograft complications. It did not show statistically significant change in the Bohler and Gissane angles even at 6 months follow up, thereby implying that there is no loss of reduction of the fracture in the absence of bone grafting.

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Large bone distractor for open reconstruction of articular fractures of the calcaneus

Cited by 12 publications

References 22 publications

Surgical treatment of displaced intra-articular calcaneal fractures: is bone grafting necessary?

Surgical treatment of displaced intra-articular calcaneal fractures: is bone grafting necessary?

Short-Term Outcomes of Open Reduction and Internal Fixation for Sanders Type III Calcaneal Fractures With and Without Bone Grafts

Change in Bohler and Gissane angles following open reduction and internal fixation without bone grafting for closed sanders type 2 and 3 calcaneal fractures

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