Session VII - Foot & Ankle

Saturday, October 23, 1999 Session VII, Paper #48, 3:57 p.m.

Bone Graft in the Operative Treatment of Displaced Intra-articular Calcaneal Fractures: Is It Helpful?

Richard E. Buckley, MD; David Longino, B.Sc., Department of Surgery, University of Calgary, Alberta, Canada

Objective: To determine whether autologous bone graft supplementation with open reduction and internal fixation (ORIF) of displaced intra-articular calcaneal fractures (DIACFs) is beneficial in achieving and maintaining restoration of calcaneal height and anatomical reduction of the posterior facet.

Design: Prospective historical cohort.

Setting: Level one trauma centre, university hospital.

Patients/Intervention: 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, pre-operative Bohler's angle, and fixation in the joint.

Main Outcome Measurements: Postoperative computed tomography assessed quality of anatomical reduction. Postoperative and 3-month follow-up radiographs assessed Bohler's angle. A validated Visual Analogue Scale (VAS), and SF-36 assessed functional outcome at a minimum of 2 years post surgery.

Results: Twenty-one fractures were 73-C2 (Sanders type III), 15 fractures were 73-C1 (Sanders II), and 4 fractures were 73-C3 (Sanders type IV). In the individually matched pairs of patients the mean pre-operative Bohler's angle was 2 degrees [standard deviation (S.D.) 14 degrees] for the bone graft group and 1 degree (S.D. 12 degrees) for the non-bone graft group. Pre-operative Bohler's angle differed between individually matched pairs an average of 4 degrees (range 0-10 degrees). Bohler's angle increased with surgery a mean of 26 degrees (S.D. 14 degrees) in the bone graft group and 27 degrees (S.D. 10 degrees) in the non-bone graft group. In the first three months postoperatively a mean decrease in Bohler's angle of 7 degrees (S.D. 4 degrees) in the bone graft group and 6 degrees (S.D. 7 degrees ) in the non-bone graft group was demonstrated. Statistical analysis of the individually matched pairs found no significant difference between the bone graft and non-bone graft patients regarding: 1) the change in Bohler's angle obtained with surgery (p=0.98); 2) the change in Bohler's angle in the 3 months following 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.