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

The role of bone grafting in the surgical treatment of displaced intra-articular calcaneal fractures (DIACFs) remains controversial. Although bone grafts are commonly used to restore joint congruity and support anatomical reduction, recent evidence favors minimally invasive approaches that may eliminate the need for routine grafting. This study aimed to evaluate the impact of bone graft use on radiological parameters and functional outcomes in Sanders Type II, III, and IV calcaneal fractures treated surgically.

This retrospective cohort study included 115 patients who underwent open reduction and internal fixation (ORIF) for DIACFs between 2016 and 2022. Fractures were classified using the Sanders classification and subgrouped as grafted (+) or non-grafted (-). Böhler and Gissane angles and calcaneal height were measured at four time points. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Intergroup and intragroup comparisons were made using appropriate statistical methods.

Of the 115 patients, 38 had Type II, 43 had Type III, and 34 had Type IV fractures. Demographics and follow-up durations were comparable across groups (p>0.05). Both grafted and non-grafted groups demonstrated significant postoperative improvements in radiological parameters (p<0.05), which gradually declined over time. No statistically significant intergroup differences were observed at any time point (p>0.05). AOFAS scores and superficial wound infection rates were also similar.

Bone grafting did not yield superior radiological or functional outcomes in Sanders Type II, III and IV DIACFs treated with ORIF. These findings support a selective approach to grafting, especially in cases with significant comminution or bone loss, and align with current trends favoring biologically friendly and minimally invasive techniques.