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Is it necessary to graft the void defect during open reduction and internal fixation of calcaneal fractures?

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MUSCULOSKELETAL SURGERY Aims and scope Submit manuscript

Abstract

Purpose

There are still controversies on the effect of grafting during open reduction and internal fixation of calcaneal fractures. The aim of this study was to compare the radiological and functional outcomes in patients with or without intraoperative grafting.

Methods

In a comparative retrospective study, among 442 operatively-treated calcaneal fractures, 60 patients with unilateral closed sanders type II intraarticular calcaneal fracture who underwent ORIF via lateral extensile approach using locking anatomical plates with at least 1 year follow-up without any postoperative wound complication were enrolled. The patients were separated into 2 groups: with bone allograft and without bone allograft. The functional outcome of the patients was assessed using visual analog scale (VAS) for pain, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, foot function index (FFI), and short-form (SF-36) health survey. Radiographic variables included Böhler angle, Gissane angle, calcaneal width, calcaneal height, and talar declination angle. Also, the differences (delta) of these values in comparison to the uninjured foot were calculated.

Results

The mean age was 39.1 ± 12.7 (range, 13–67) years with 54 males, 90.0%. No statistically significant differences were detected in age, gender, affected side, and subtypes of calcaneal fractures between the two groups (p > 0.05). The average follow-up was 25.1 (range, 12–48) months. The differences for all radiographic measurements and also, the delta values between the groups were not statistically significant, except talar declination angle which was more in cases without grafting (p = 0.007). Although the differences between the two groups regarding AOFAS ankle-hindfoot scale (p = 0.257), VAS for pain (p = 0.645), and FFI (p = 0.261) were not statistically significant; the group with bone graft experienced less pain (19.7 ± 22.0) than the other group (26.7 ± 22.8). The difference between the groups was not statistically significant (p = 0.87) according to the SF-36 questionnaire.

Conclusions

Incorporating allografts into the void defects during ORIF of displaced intraarticular calcaneal fractures may not improve functional outcomes and recover postoperative radiological parameters. Therefore, routine use of allograft to fill the defects during ORIF of calcaneus may not be recommended. Of note, that these findings solely relate to the treatment of Sanders type II fractures.

Level of evidence III

Comparative retrospective study.

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Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Yu Q, Li Z, Li J, Yu Q, Zhang L, Liu D, Zhang M, Tang P (2022) Calcaneal fracture maps and their determinants. J Orthop Surg Res 17(1):39. https://doi.org/10.1186/s13018-022-02930-y

    Article  PubMed  PubMed Central  Google Scholar 

  2. Vosoughi AR, Afaridi E, Solooki S, Shayan Z, Rammelt S (2023) Prevalence and predictors of peroneal tendon instability accompanying calcaneal fractures. Foot Ankle Int 44(9):825–833

    Article  PubMed  Google Scholar 

  3. Vosoughi AR, Borazjani R, Ghasemi N, Fathi S, Mashhadiagha A, Hoveidaei AH (2022) Different types and epidemiological patterns of calcaneal fractures based on reviewing CT images of 957 fractures. Foot Ankle Surg Off J Eur Soc Foot Ankle Surg 28(1):88–92. https://doi.org/10.1016/j.fas.2021.02.002

    Article  Google Scholar 

  4. Lin SS (2021) CORR Insights®: bone defects after surgery for displaced intraarticular calcaneal fractures spontaneously improve without bone grafting. Clin Orthop Relat Res 479(6):1273–1274. https://doi.org/10.1097/corr.0000000000001690

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zheng W, Xie L, Xie H, Chen C, Chen H, Cai L (2018) With versus without bone grafts for operative treatment of displaced intra-articular calcaneal fractures: a meta-analysis. Int J Surg (London, England) 59:36–47. https://doi.org/10.1016/j.ijsu.2018.09.016

    Article  Google Scholar 

  6. Yang Y, Zhao H, Zhou J, Yu G (2012) Treatment of displaced intraarticular calcaneal fractures with or without bone grafts: a systematic review of the literature. Indian J Orthop 46(2):130–137. https://doi.org/10.4103/0019-5413.93672

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tian H, Guo W, Zhou J, Wang X, Zhu Z (2021) Bone graft versus non-bone graft for treatment of calcaneal fractures: a protocol for meta-analysis. Medicine 100(2):e24261–e24261. https://doi.org/10.1097/MD.0000000000024261

    Article  PubMed  PubMed Central  Google Scholar 

  8. Duymus TM, Mutlu S, Mutlu H, Ozel O, Guler O, Mahirogullari M (2017) Need for bone grafts in the surgical treatment of displaced intra-articular calcaneal fractures. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg 56(1):54–58. https://doi.org/10.1053/j.jfas.2016.08.004

    Article  Google Scholar 

  9. Sonmez MM, Armagan R, Ugurlar M, Eren T (2017) Allografts versus equine xenografts in calcaneal fracture repair. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg 56(3):510–513. https://doi.org/10.1053/j.jfas.2017.01.015

    Article  Google Scholar 

  10. Wei LC, Lei GH, Sheng PY, Gao SG, Xu M, Jiang W, Song Y, Luo W (2012) Efficacy of platelet-rich plasma combined with allograft bone in the management of displaced intra-articular calcaneal fractures: a prospective cohort study. J Orthop Res Off Publ Orthop Res Soc 30(10):1570–1576. https://doi.org/10.1002/jor.22118

    Article  Google Scholar 

  11. Gusic N, Fedel I, Darabos N, Lovric Z, Bukvic N, Bakota B, Lemac D (2015) Operative treatment of intraarticular calcaneal fractures: anatomical and functional outcome of three different operative techniques. Injury 46(Suppl 6):S130-133. https://doi.org/10.1016/j.injury.2015.10.061

    Article  PubMed  Google Scholar 

  12. Longino D, Buckley RE (2001) Bone graft in the operative treatment of displaced intraarticular calcaneal fractures: is it helpful? J Orthop Trauma 15(4):280–286

    Article  CAS  PubMed  Google Scholar 

  13. Zhang L, Zhao WZ, Fang X, He SW, Mi LD, Du GY, Sun CX, Sun XG (2011) A study of 22 displaced intraarticular calcaneal fractures using locking plates with and without bone graft. Zhongguo gu shang China J Orthop Traumatol 24(4):305–307

    Google Scholar 

  14. Di Schino M, Bensaïda M, Vandenbussche E, Augereau B, Nich C (2008) Results of open reduction and cortico-cancellous autograft of intra-articular calcaneal fractures according to Palmer. Rev Chir Orthop Reparatrice Appar Mot 94(8):e8-16. https://doi.org/10.1016/j.rco.2007.04.007

    Article  PubMed  Google Scholar 

  15. Liang J, Cao HB, Xin JY (2012) Therapeutic efficacies of bone grafing for calcaneal intra-calcaneal fractures. Zhonghua Yi Xue Za Zhi 92(3):197–199

    PubMed  Google Scholar 

  16. Zhang Q (2009) Treatment of intra-articular calcaneal fracture by bone grafting and plastic ti-alloy plate internal fixation. Zhongguo xiu fu chong jian wai ke za zhi Zhongguo xiufu chongjian waike zazhi Chin J Repar Reconstr Surg 23(6):648–650

    Google Scholar 

  17. Vosoughi AR, Tamadon A, Gholamzadeh S, Fereidooni M (2021) Can we release all calcaneal attachments of the superior peroneal retinaculum during extensile lateral approach to the calcaneus? J Foot Ankle S Off Publ Am Coll Foot Ankle Surg 60(1):85–88. https://doi.org/10.1053/j.jfas.2020.09.005

    Article  Google Scholar 

  18. Vosoughi AR, Roustaei N, Mahdaviazad H (2018) American Orthopedic foot and ankle society ankle-hindfoot scale: a cross-cultural adaptation and validation study from Iran. Foot Ankle Surg Offi J Eur Soc Foot Ankle Surg 24(3):219–223. https://doi.org/10.1016/j.fas.2017.02.007

    Article  Google Scholar 

  19. Schepers T, Ginai AZ, Mulder PG, Patka P (2007) Radiographic evaluation of calcaneal fractures: to measure or not to measure. Skeletal Radiol 36(9):847–852. https://doi.org/10.1007/s00256-007-0330-6

    Article  CAS  PubMed  Google Scholar 

  20. Fourgeaux A, Estens J, Fabre T, Laffenetre O, Lucas y Hernandez J (2019) Three-dimensional computed tomography analysis and functional results of calcaneal fractures treated by an intramedullary nail. Int Orthop 43(12):2839–2847

    Article  PubMed  Google Scholar 

  21. Geel CW, Flemister ASJ (2001) Standardized treatment of intra-articular calcaneal fractures using an oblique lateral incision and no bone graft. J Trauma Acute Care Surg 50(6):1083–1089

    Article  CAS  Google Scholar 

  22. Singh AK, Vinay K (2013) Surgical treatment of displaced intra-articular calcaneal fractures: is bone grafting necessary? J Orthop Traumatol Off J Ital Soc Orthop Traumatol 14(4):299–305. https://doi.org/10.1007/s10195-013-0246-y

    Article  CAS  Google Scholar 

  23. Park YH, Cho HW, Choi JW, Choi GW, Kim HJ (2021) Bone defects after surgery for displaced intraarticular calcaneal fractures spontaneously improve without bone grafting. Clin Orthop Relat Res 479(6):1265–1272. https://doi.org/10.1097/corr.0000000000001634

    Article  PubMed  PubMed Central  Google Scholar 

  24. Feng Y, Shui X, Wang J, Cai L, Yu Y, Ying X, Kong J, Hong J (2016) Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures: a prospective randomized controlled trial. BMC Musculoskelet Disord 17:288. https://doi.org/10.1186/s12891-016-1122-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Jiang SD, Jiang LS, Dai LY (2008) Surgical treatment of calcaneal fractures with use of beta-tricalcium phosphate ceramic grafting. Foot Ankle Int 29(10):1015–1019. https://doi.org/10.3113/fai.2008.1015

    Article  PubMed  Google Scholar 

  26. Labbe JL, Peres O, Leclair O, Goulon R, Scemama P, Jourdel F (2013) Minimally invasive treatment of displaced intra-articular calcaneal fractures using the balloon kyphoplasty technique: preliminary study. Orthop Traumatol Surg Res OTSR 99(7):829–836. https://doi.org/10.1016/j.otsr.2013.06.008

    Article  CAS  PubMed  Google Scholar 

  27. Cao H, Li YG, An Q, Gou B, Qian W, Guo XP, Zhang Y (2018) Short-term outcomes of open reduction and internal fixation for sanders type III calcaneal fractures with and without bone grafts. J Foot Ankle Surg Off Publ Am Coll Foot Ankle Surg 57(1):7–14. https://doi.org/10.1053/j.jfas.2017.05.037

    Article  Google Scholar 

  28. Gougoulias N, McBride D, Maffulli N (2021) Outcomes of management of displaced intra-articular calcaneal fractures. Surg J Royal Coll Surg Edinburgh Irel 19(5):e222–e229. https://doi.org/10.1016/j.surge.2020.10.003

    Article  Google Scholar 

  29. Kordi Yoosefinejad A, Khademi S, Vosoughi AR (2021) Consequences of extensile lateral approach to the calcaneal fractures on balance and isokinetic strength of muscle groups crossing the ankle joint. Foot Ankle Surg Off J Eur Soc Foot Ankle Surg. https://doi.org/10.1016/j.fas.2021.09.001

    Article  Google Scholar 

  30. Rammelt S, Swords MP (2021) Calcaneal fractures-which approach for which fracture? Orthop Clin North Am 52(4):433–450. https://doi.org/10.1016/j.ocl.2021.05.012

    Article  PubMed  Google Scholar 

  31. Vosoughi AR, Medhati P, Hosseini E, Labidi M, Hoveidaei AH (2023) Clinical outcomes following treatment of deep surgical site infection after fixation of calcaneal fractures: a retrospective case-control study. Foot Ankle Surg Off J Eur Soc Foot Ankle Surg 29(4):334–340. https://doi.org/10.1016/j.fas.2023.04.003

    Article  Google Scholar 

  32. Hashemi SA, Mehboudi M, Hoveidaei AH, Vosoughi AR (2024) Correlation between clinical outcome and radiologic features after open reduction and internal fixation of calcaneal fractures. J Am Podiatr Med Assoc. https://doi.org/10.7547/22-085

    Article  PubMed  Google Scholar 

  33. Sanders R, Fortin P, DiPasquale T, Walling A (1993) Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res 290:87–95

    Article  Google Scholar 

  34. Vosoughi AR, Shayan Z, Salehi E, Jaberi FM, Solooki S, Kardeh B (2020) Agreement between Sanders classification of intraarticular calcaneal fractures and assessment during the surgery. Foot Ankle Surg Off J Eur Soc Foot and Ankle Surg 26(1):94–97. https://doi.org/10.1016/j.fas.2018.12.001

    Article  Google Scholar 

  35. Brognara L, Mazzotti A, Arceri A, Artioli E, Casadei G, Bonelli S, Traina F, Faldini C (2023) Patient reported outcome measures (PROMs) in surgery: evaluation after minimally invasive reduction and percutaneous K-wires fixation for intra-articular calcaneal fractures. Diseases 11(2):57. https://doi.org/10.3390/diseases11020057

    Article  PubMed  PubMed Central  Google Scholar 

  36. Shams A, Gamal O, Mesregah MK (2023) Minimally invasive reduction of intraarticular calcaneal fractures with percutaneous fixation using cannulated screws versus kirschner wires: a retrospective comparative study. Foot Ankle Spec 16(1):28–35. https://doi.org/10.1177/1938640020987750

    Article  PubMed  Google Scholar 

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Acknowledgements

This article has been obtained from a thesis (registered no. 19596) submitted to the Shiraz University of Medical Sciences in partial fulfillment of the requirement for the degree of specialty in orthopedic surgery. The project is sponsored by Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences.

Funding

The project was financed by Vice Chancellor for Research of the Shiraz University of Medical Science (Grant No. 19596).

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Authors and Affiliations

  1. Bone and Joint Diseases Research Center, Department of Orthopedic Surgery, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    S. A. Hashemi & A. R. Vosoughi

  2. Shiraz University of Medical Sciences, Shiraz, Iran

    B. Yazdanpanah

  3. Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

    R. Borazjani

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Contributions

A.R.V contributed to the conception and design of the work, performing all surgeries, revising the draft critically for important intellectual content study. B.Y contributed to gather the data by visiting the patients and studying the files of the patients, and drafting of the paper. R.B. contributed to the design of the work, data analysis, preparing the primary draft of manuscript. S.A.H contributed to design of the work, measure the radiological variables, and drafting of the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to A. R. Vosoughi.

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Conflict of interests

All the authors have no conflict of interest and received no financial support for the research, authorship, and/or publication of this article.

Ethical approval

This study was performed after the approval of the study by the ethical committee of Shiraz University of Medical Sciences in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Approval ID IR.SUMS.MED.REC. 1399.036 (https://ethics.research.ac.ir/ProposalCertificateEn.php?id=198841&Print=true&NoPrintHeader=true&NoPrintFooter=true&NoPrintPageBorder=true&LetterPrint=true).

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We asked the patients for follow-up visit, moreover written informed consent letters were signed by the patients.

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Hashemi, S.A., Yazdanpanah, B., Borazjani, R. et al. Is it necessary to graft the void defect during open reduction and internal fixation of calcaneal fractures?. Musculoskelet Surg 108, 231–238 (2024). https://doi.org/10.1007/s12306-024-00819-z

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