Open reduction and internal fixation plus artificial bone graft for treatment of Sanders type III and IV calcaneal fractures

Abstract

Objective To investigate the effects of open reduction and internal fixation plus calcium sulfate artificial bone graft for the treatment of Sanders type III and IV calcaneal fractures. Methods The clinical data of patients with Sanders type III and IV calcaneal fractures treated from January 2012 to December 2015 were retrospectively reviewed by case-control study. The patients were divided into two groups as bone graft group (open reduction and internal fixation combined with artificial bone graft) and control group (open reduction and internal fixation). The bone graft group was composed of 17 cases, among which there were 12 males and five females with age range of 19-62 years [(41.6±12.9) years]. In bone graft group, there were 12 cases of Sanders III and five cases of Sanders IV. The control group was composed of 13 cases, among which there were eight males and five females with age range of 20-59 years [(39.4±11.8) years]. In control group, there were ten cases of Sanders III and three cases of Sanders IV. The follow-up visits were done at 1, 2, 3, 6, and 12 months after surgery with record of complication occurrence. The changes of Bohler's angle and Gissan's angle were observed preoperatively as well as at 2 days and 12 months after surgery. The function recovery was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score at final follow-up visit. Results Five cases of marginal necrosis of the incision and two cases of superficial soft tissue infection were seen in bone graft group, while there were two cases of marginal necrosis of the incision and one cases of superficial soft tissue infection in control group. In early postoperative comparison between two groups, the variation of Bohler's angle and Gissan's angle had no significant difference (P>0.05). At 12 months after surgery, Bohler's angle of bone graft and control groups were (23.2±9.0)° and (19.5±11.1)°, respectively. The losses of Bohler's angle were (3.6±2.7)°and (6.9±3.1)°, respectively. The difference in the losses of angle in two groups had statistical significance (P 0.05). At the final follow-up, bone union was found in all cases, and there was no significant difference in AOFAS score between the two groups (P>0.05). Conclusions Open reduction and internal fixation can attain good treatment results for Sanders type III and IV calcaneal fractures, no matter whether bone graft is carried out. However, artificial bone graft may have good effects to sustain the stability of fracture fragments and provide early mechanical support for the subtalar joint. Key words: Calcaneus; Fracture fixation, internal; Bone transplantation; Calcium sulfate artificial bone