Does Grafting Matter in Surgically Treated Calcaneal Fractures? A Retrospective Analysis

Area of Science:

• Orthopedic Surgery
• Traumatology
• Radiology

Background:

• Displaced intra-articular calcaneal fractures (DIACFs) pose treatment challenges.
• The necessity of bone grafting in surgical repair of DIACFs is debated.
• Minimally invasive techniques are gaining traction, potentially reducing the need for grafting.

Purpose of the Study:

• To evaluate the impact of bone graft utilization on radiological and functional outcomes in surgically treated Sanders Type II, III, and IV DIACFs.
• To compare outcomes between grafted and non-grafted groups undergoing open reduction and internal fixation (ORIF).

Main Methods:

• Retrospective cohort study of 115 patients with DIACFs (2016-2022).
• Fractures classified by Sanders criteria and divided into grafted and non-grafted groups.
• Radiological parameters (Böhler/Gissane angles, calcaneal height) and American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores were assessed.

Main Results:

• Both grafted and non-grafted groups showed significant postoperative improvements in radiological parameters, with no significant intergroup differences.
• Functional outcomes (AOFAS scores) and superficial wound infection rates were comparable between the groups.
• No statistically significant differences in radiological or functional outcomes were observed between grafted and non-grafted DIACFs at any time point.

Conclusions:

• Bone grafting does not offer superior radiological or functional benefits for Sanders Type II, III, and IV DIACFs treated with ORIF.
• Findings support a selective approach to bone grafting in DIACFs, particularly in cases without significant comminution or bone loss.
• Results align with trends towards biologically friendly and minimally invasive surgical techniques for calcaneal fractures.