J Korean Foot Ankle Soc.  2017 Mar;21(1):27-32. 10.14193/jkfas.2017.21.1.27.

Tricortical-allobone Grafting in Screw Fixation for Intra-articular Calcaneal Fracture via Ollier Approach

• Bang T
• Bae SY
• Woo SH
• Chung HJ

• KMID: 2371971
• DOI: http://doi.org/10.14193/jkfas.2017.21.1.27

Abstract

PURPOSE
Bone grafting is often necessary to maintain a reduction and prevent delayed collapse of reduced fracture in a treatment of severely displaced comminuted intra-articular calcaneal fractures. Herein, we analyzed the usefulness and necessary conditions to perform tricortical-allobone grafting in open reduction of calcaneal fracture via the Ollier approach.
MATERIALS AND METHODS
We performed a retrospective review of 57 intra-articular calcaneal fractures that underwent an operation via the Ollier approach between April 2009 and April 2015. They were divided into two groups: Group 1 (n=17) included those with tricortical-allobone grafts underneath the posterior facet fragment, and group 2 (n=40) included cases without a bone graft. We measured the Böhler angle, Gissane angle, height, and width of the calcaneus at preoperative, postoperative, and final follow-up radiograph. We measured the sagittal rotational angle of the posterior facet fragment of preoperative computed tomography to analyze the effect and necessary conditions for bone grafting. We also reviewed the clinical results by the American Orthopaedic Foot and Ankle Society (AOFAS) scale, visual analogue scale (VAS), and any complications.
RESULTS
According to the Sanders classification, there were 3 type-II fractures, 12 type-III fractures, and 2 type-IV fractures in Group 1; whereas in Group 2, there were 26 type-II fractures, 13 type-III fractures, and 1 type-IV fracture (p=0.002). Regarding the preoperative radiologic parameters, there were significant differences in the Böhler angle (p=0.006), Gissane angle (p=0.043), and rotational angle of the posterior facet fragment (p=0.001). No significant difference was observed in the preoperative calcaneal height and width, as well as postoperative radiologic parameters. There was no significant clinical difference between the two groups (p=0.546).
CONCLUSION
We suggest that a tricortical-allobone graft may be useful in open reduction and screw fixation via the Ollier approach for displaced intra-articular calcaneal fracture with a bony defect after reduction of collapsed posterior facet fragment. This graft can contribute to the stable reduction via a small approach, even without a plate.

Keyword

Calcaneus; Intra-articular fracture; Tricortical-allobone graft; Ollier approach

MeSH Terms

Ankle
Bone Transplantation
Calcaneus
Classification
Follow-Up Studies
Foot
Intra-Articular Fractures
Retrospective Studies
Transplants*

Figure

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  Figure 1. Fixation with screws and grafting with tricortical-allobone. Lateral view (A) and axial view (B) of radiographs.

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  Figure 2. Posterior facet fragment rotation angle.

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  Figure 3. Tricortical-allobone graft.

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