Sanders type 3&amp;ndash;4 calcaneal fractures fixed with locking plate: does tri-cortical iliac bone autograft provide extra benefit for stabilization?

Bulut, Tuğrul; Öztürk, Tahir; Özcan, Cihat; Şener, Muhittin

doi:10.2147/tcrm.s146530

Cited by 4 publications

(4 citation statements)

References 29 publications

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“…This result supports previous studies that concluded that bone grafting is not necessary for the treatment of calcaneal fractures. Bulut et al [2] reported that bone grafting provides no extra stabilization benefit in Sanders Type III and IV calcaneal fractures. Longino and Buckley [14] found no objective radiographic or functional benefit to the use of bone grafts in the surgical treatment of displaced intraarticular calcaneal fractures.…”

Section: Discussionmentioning

confidence: 99%

“…Even though this study showed favorable results without bone grafting, this alone cannot rule out the possibility that bone grafting would have better results in pain relief or preventing joint collapse. However, we did not perform bone grafting based on the results of previous studies [2,14,23]; hence, the study results could not be compared with studies that used bone grafting. Second, as bone remodeling continues over 12 months of follow-up, residual bone defect may have late effects on the radiographic or clinical outcomes.…”

Section: Limitationsmentioning

confidence: 99%

“…The authors who advocate for bone grafting insist that it has the advantage of mechanical support and biological stimulation for recovery [7,24]. However, according to other authors, bone grafting offers no such benefit [2,14,23]. In addition, several studies have reported that bone grafting increases complication risks such as donor site morbidity and infection transmission [3,8].…”

Section: Introductionmentioning

confidence: 99%

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Bone Defects After Surgery for Displaced Intraarticular Calcaneal Fractures Spontaneously Improve Without Bone Grafting

Park

Cho

Choi

et al. 2021

Clin Orthop Relat Res

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Background Most intraarticular displaced calcaneal fractures are accompanied by bone defects after surgical treatment, but the concern about negative effects of bone defects has not been resolved yet owing to the few studies on this issue. Therefore, studies on volumetric changes in bone defects over time and the correlation between postoperative outcomes and residual bone defects will be helpful to address the controversy on the necessity of bone grafting in bone defects of calcaneal fractures. Questions/purposes (1) Do bone defects change in size in the first year after surgical treatment of displaced intraarticular calcaneal fractures? (2) Does the size of residual bone defects correlate with postoperative radiographic or clinical outcomes? Methods Between 2015 and 2019, 99 patients with displaced intraarticular calcaneal fractures visited the investigators’ institution, of whom 95 received surgical treatment. Of the patients treated with surgery, 25% (24 of 95) did not undergo open reduction and internal fixation via an extensile lateral approach, and 19% (18 of 95) had multiple fractures, bilateral fractures, open fractures, or a history of previous surgery on the calcaneus; all of these patients were excluded. During the study period, CT was routinely performed for calcaneal fractures immediately after and 12 months after the surgery, but 6% (6 of 95) of the patients had insufficient CT data due to loss to follow-up before 12 months or other reasons, leaving 47 patients for evaluation in this retrospective study. Fractures were fixed with plate and screws, and bone grafting was not performed in all patients. To answer our first question, which was on the changes in bone defects over time, volumetric measurements of the bone defect were performed using CT via the ITK-SNAP software. The percentage of volumetric change was calculated as a fraction of the volumetric change over 12 months from the initial volume. The percentage of the residual bone defect was calculated as a fraction of the volume of the residual bone defect relative to the volume of the entire calcaneus. To answer our second question, which was on the correlation between residual bone defects and postoperative outcomes, we assessed the Böhler angle, Gissane angle, calcaneal height, Olerud-Molander Ankle Score (OMAS), and VAS score for pain and compared these parameters with the size of the residual bone defect using the Pearson correlation coefficient. The OMAS and VAS scores for pain were evaluated and recorded during patient visits, and we obtained the scores through a chart review. All volumetric measurements and radiographic evaluations were performed by two orthopaedic surgeons, and the intraobserver and interobserver reliability were assessed using the intraclass correlation coefficient. Results The mean volume of the bone defect measured using CT was 4 ± 3 cm3 immediately after surgery and 1 ± 1 cm3 12 months after surgery. During the first 12 months after surgery, the mean volume of the bone defect was reduced by 77% (95% confidence interval 73% to 80%). The mean residual bone defect in the entire calcaneus was 2% (95% CI 1% to 2%), and none of the postoperative outcomes were correlated with the residual bone defect. Conclusion As bone defects substantially resolve without treatment, surgeons do not need to use bone graft for the surgical treatment of displaced intraarticular calcaneal fractures. Future studies that include patients who underwent bone grafting for the treatment of calcaneal fractures are needed to confirm our findings and to further investigate whether bone grafting has additional benefits for the recovery of bone defects. Level of Evidence Level III, therapeutic study.

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bone Defects After Surgery for Displaced Intraarticular Calcaneal Fractures Spontaneously Improve Without Bone Grafting

Park

Cho

Choi

et al. 2021

Clin Orthop Relat Res

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“…2,3 The use of bone grafting in fracture xation for cases with bone defects remains popular, despite the lack of substantial evidence to support its e cacy and bene ts. [4][5][6][7] Most of the calcaneal fractures are severe and compound fractures with intra-articular fragment displacement and posterior articular facet collapse (i.e., displaced intra-articular fracture). The occurrence of articular facet collapse may lead to the occurrence of bone defects that affect the outcomes of xation.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical role of bone grafting for calcaneal fracture fixation in the presence of bone defect: A finite element analysis

Su,

Ding,

Zhu

et al. 2024

Clinical Biomechanics

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Biomechanical Role of Bone Grafting for Calcaneal Fracture Fixation in the Presence of Bone Defect: A Finite Element Analysis

Su,

Ding,

Zhu

et al. 2023

Preprint

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Background The purpose of this study was to compare the biomechanical stress and stability of calcaneal fixations with and without bone defect, before and after bone grafting, through a computational approach. Methods A finite element model of foot-ankle complex was reconstructed, impoverished with a Sanders III calcaneal fracture without bone defect and with moderate and severe bone defects. Plate fixations with and without bone grafting were introduced with walking stance simulated. The stress and fragment displacement of the calcaneus were evaluated. Results Moderate and severe defect increased the calcaneus stress by 16.11% and 32.51%, respectively and subsequently decreased by 10.76% and 20.78% after bone grafting. The total displacement was increased by 3.99% and 24.26%, respectively by moderate and severe defect, while that of posterior joint facet displacement was 86.66% and 104.44%. The former was decreased by 25.73% and 35.96% after grafting, while that of the latter was reduced by 88.09% and 84.78% for moderate and severe defect, respectively. Conclusions Our FE prediction supported that bone grafting for fixation could enhance the stability and reduce the risk of secondary stress fracture in cases of bone defect in calcaneal fracture.

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Sanders type 3–4 calcaneal fractures fixed with locking plate: does tri-cortical iliac bone autograft provide extra benefit for stabilization?

Cited by 4 publications

References 29 publications

Bone Defects After Surgery for Displaced Intraarticular Calcaneal Fractures Spontaneously Improve Without Bone Grafting

Bone Defects After Surgery for Displaced Intraarticular Calcaneal Fractures Spontaneously Improve Without Bone Grafting

Biomechanical role of bone grafting for calcaneal fracture fixation in the presence of bone defect: A finite element analysis

Biomechanical Role of Bone Grafting for Calcaneal Fracture Fixation in the Presence of Bone Defect: A Finite Element Analysis

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