The Operative Treatment using Porous Hydroxyapatite for Intraarticular Calcaneal Fractures of Joint Depression Type

Choi, Eui Sung; Kim, Yong Min; Kim, Dong Soo; Shon, Hyun Chul; Park, Kyoung Jin; Cho, Byung Ki; Park, Ji Kang; Yoo, Jun il

Abstract

PURPOSE
This study was performed to evaluate the clinical outcomes of operative treatment using porous hydroxyapatite for intraarticular calcaneal fracture of joint depression type.
MATERIALS AND METHODS
Twenty patients with intraarticular calcaneal fracture were followed up for more than 1 year. The period to union was calculated to evaluate the osteoconductivity of porous hydroxyapatite used as bone graft substitute. The measurement of Bohler angle, Gissane angle and the degree of articular surface depression was performed through preoperative and postoperative radiographs. The clinical evaluation was performed according to hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and scale of the Creighton-Nebraska health foundation (CNHF).
RESULTS
Bohler angle and Gissane angle had improved significantly from preoperative average 10.4degrees, 117.8degrees to average 22.6degrees, 113.5degrees immediate postoperatively, and had maintained to average 21.2degrees and 114.4degrees at the last follow-up. The degree of articular surface depression had improved significantly from preoperative average 4.8 mm to 1.5 mm at the last follow-up. All cases achieved bone union, and the interval to union was average 12.8 weeks. AOFAS score was average 85.2 points at last follow-up. There were 7 excellent, 10 good, and 3 fair results according to the CNHF scale. Therefore, 17 cases (85%) achieved satisfactory results.
CONCLUSION
Plate fixation using porous hydroxyapatite seems to be one of effective treatment methods for intraarticular calcaneal fracture of joint depression type, because of supporting the reduction of subtalar articulation by augmenting bony defect and facilitating bone formation. Further evaluation about long-term radiological changes and histological analysis on hydroxyapatite implantation site should be required.