Intra-Articular Calcaneal Fracture Surgery: A Comparison Between Open Reduction and Internal Fixation Using Auto Graft vs Bone Cement

Anatomical reconstruction of articular surface and restoration of walking ability without pain are the main goals of displaced intra-articular calcaneal fracture management, but treatment results are not always satisfied. This paper focused on comparison between open reduction and internal fixation using: A) auto graft B) bone cement, in patients with displaced intra-articular calcaneal fracture. This prospective comparative study of 44 patients with displaced intra-articular calcaneal fractures. Patients had been divided into 2 groups and then, they were operated by the standard protocol, including lateral approach, open reduction and internal fixation with reconstruction plate. Posterior facet was supported by autogenous bone graft in the first group (BG) and it was strengthened by bone cement in the second group (BC). Patients were followed up from the point of view of following surgical complications: 1- superficial infection, 2- wound dehiscence, 3- incisional site skin necrosis, 4- Sural nerve paresthesia, 5- osteomyelitis. Functional outcome were evaluated using calcaneal fracture scoring system and ankle-hind foot scaling system of AOFAS. The gathered data was analyzed in SPSS 16 software. Of 44 included patients, 36 were male (81.8%) and eight were female (18.2%). The mean of age was 44.25± 11.34 (range: 16-69 yrs), and the mean of follow-up duration was 13.27±2.71 months (range: 9-18 months). The mean of operation time in second group (BC) (41.82min) was significantly lower than first group (BG), (p <0.001). Five patients (23%) from first group (BG) and only one patient (5%) from the second group (BC) showed surgical complications (p =0.079). There was no significant difference between the average score evaluated by calcaneal fracture scoring system and the average scale indicated by ankle-hind foot scaling system. Instead of autogenous bone graft, the use of bone cement decreases the duration of operation time and it seems to lead in less complications.