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. Design: Prospective historical cohort. Setting: Level I trauma center, university hospital. Patients and 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, preoperative Bohler's angle, and fixation in the joint. Main Outcome Measurements: Postoperative computed tomography assessed quality of anatomic reduction. Postoperative and three-month follow-up radiographs assessed Bohler'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 73C1 (Sanders Type II); and four fractures were 73-C3 (Sanders Type IV). In the individually matched pairs of patients, the mean preoperative Bohler's angle was 2 degrees (standard deviation [SD] 14 degrees) for the bone graft group and I degree (SD 12 degrees) for the non-bone graft group. Preoperative Bohler's angle differed between individually matched pairs an average of 4 degrees (range 0 to 10 degrees). Bohler'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. Tn the first three months after surgery, a mean decrease in Bohler'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 Bohler's angle obtained with surgery (p = 0.98) and the change in Bohler'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 hone graft. No differences in functional outcome were detected. Conclusions: We found Ilo objective radiographic or functional benefit to the use of bone graft supplementation in the operative treatment of DIACFs.