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

Singh, Ashutosh Kumar; Vinay, K N

doi:10.1007/s10195-013-0246-y

Cited by 43 publications

(33 citation statements)

References 30 publications

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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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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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“…Worse [13] and better [15] outcomes have reported in other studies. A systematic review of literature comparing outcome of treatment of DIACF with and without bone grafting, displayed similar results for both methods [17], but after separating by reported score, patients with bone grafting had lower mean AOFAS score but a higher mean Creighton score.…”

Section: Discussionmentioning

confidence: 58%

“…Therefore, ORIF is getting method of interest for treatment of DIACF. Although the use of bone grafting in management of DIACF have an old history in medical practice, its usefulness is not still clear [13]. Rate of definite and occasionally use of bone graft in ORIF has been reported to be 20% and 42% in nationwide study in Netherlands, respectively [14].…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Displaced Intra-Articular Calcaneal Fracture with Tri-Cortical Iliac Bone Graft

Madadi¹,

Madadi²,

Moghaddam³

et al. 2018

J Bone Res

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Management of displaced intra-articular calcaneal fracture has remained unclear for orthopedic surgeons and there is controversy to choose the best methods of treatment. Wide range of post-operative complications and variety of outcomes cause this complexity. Although, there is no strong evidence, in which support superior benefit of bone grafting in treatment of DIACF, it is still a popular method. The objective of this study was to present outcome and complications of surgical management of DIACF with tri-cortical iliac bone graft. Fifty-three cases containing 47 men (57 feet) and six women (7 feet) with DIACF underwent surgery by mean of tri-cortical auto graft bone from iliac crest. AOFAS hind foot scale (consist of subjective and objective variables including three major categories pain, function and alignment) and VAS questionnaires were used for full assessment of post-operative outcomes and complications. Mann-Whitney U test was used to compare means. The mean ± SD AOFAS hind foot score was 88.18 ± 7.12. AOFAS hind foot and VAS scores showed no significant difference between male and female. Nevertheless, better outcome of surgery among those below 35 year of age based on AOFAS hind foot score. Use of bone graft for treatment of DIACF might yield better results, however, the results probably differ in various conditions and situations. At the end, we recommend comparing results of different methods of treatment of DIACF by one large clinical trial with under the control of confounders.

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“…Singh & Vinay evaluated over 300 patients with calcaneal fractures fixed with a plate, and compared those who were grafted, and those who weren't [17]. Those grafted had better restoration of Bohler's angle both immediately and after 2 years, and were able to bear weight earlier.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Alterations of Calcaneal Height on the Ankle and Chopart’s Joint: A Cadaveric Study

Yousri¹,

Se²,

Atkins³

2017

Clin Res Foot Ankle

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Fracture of the calcaneum is common, and the majority are displaced intra-articular fracture patterns. Over the last three decades there have been considerable advances in the management of this injury. Open reduction and internal fixation is an accepted treatment for displaced fractures, and percutaneous techniques are now emerging. However, surgical treatment remains controversial, and many fractures are still managed conservatively.Non-operative management of displaced fractures may result in a disabling fracture malunion. The malunion is often a widened and depressed calcaneum, with subtalar joint disruption. This creates a five time risk of requiring a subtalar arthrodesis within 5 years of injury. Affected patients are frequently men of working age, with potentially significant socioeconomic consequences. Bone Block Distraction Arthrodesis (BBDA) is a technique used for the management of calcaneal malunion. In BBDA, restoration of the talocalcaneal height has been described for reconstitution of the talocalcaneal relationship. By restoring the talo calcaneal height, anterior tibio-talar impingement is relieved and ankle dorsiflexion range improved.In our clinical experience we have also noted a rotational change in the talus with loss of calcaneal height. We hypothesised that depression of the calcaneal articular surface causes extension of the talus in the sagittal plane, causing anterior tibiotalar impingement, but additionally, incongruity of the talonavicular joint. This hypothesis is important in surgical correction, because classical BBDA may need to be modified to include reversal of the abnormal talar rotation to restore Chopart's joint alignment. Appropriate restoration of the subtalar joint surface and talonavicular joint anatomy is likely to reduce the need for arthrodesis, and improve function.This cadaveric study is a proof of concept aiming to demonstrate changes in talar inclination and talo-navicular joint alignment following loss of calcaneum height, as is the case in calcaneum malunion, and then following restoration of the calcaneal height as in BBDA.

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

Cited by 43 publications

References 30 publications

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

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

Surgical Treatment of Displaced Intra-Articular Calcaneal Fracture with Tri-Cortical Iliac Bone Graft

The Effect of Alterations of Calcaneal Height on the Ankle and Chopart’s Joint: A Cadaveric Study

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