[Application of allograft bone transplantation in treatment of displaced intra-articular calcaneal fractures].

Objective: To investigate the operative treatment of displaced intra-articular calcaneal fractures (DIACFs) using a combination of small lateral incision approach and internal fixation and allograft bone transplantation.
Methods: From January 2005 to December 2007, 28 patients with 34 DIACFs were treated with open reduction, allograft bone transplantation and internal fixation through a small lateral incision approach. Of them, there were 18 males and 10 females, aged 16-65 years. The disease course was 2 hours to 18 days. According to Sanders classification, there were 18 cases of type II fractures, 10 cases of type III fractures and 6 cases of type IV fractures.
Results: 22 patients with 28 DIACFs were followed up 18.5 months (13-28 months). The wound of 26 feet achieved primary healing, the acute rejection was found in 2 patients and developed wound complications. Both patients underwent further surgery prior wound healing. After the internal fixation were removed, fractures was fixed with external fixator, closed continuous irrigation and drainage was employed. In the meantime, both patients received antibiotics and incisional dressing change. As a result, one achieved primary healing, the other developed delayed healing. The preoperative X-ray film showed that Böhler angle was (6.19 +/- 9.66) degrees and Gissane angle was (103.04 +/- 15.03) degrees; the postoperative X-ray film demonstrated that Böhler angle was (34.51 +/- 5.89) degrees and Gissane angle was (112.18 +/- 10.50) degrees; showing statistically significant differences (P < 0.05). The internal fixation of 12 patients (14 DIACFs) were removed at 6 -10 months after operation, Böhler angle was (32.81 +/- 5.10) degrees and Gissane angle was (110.81 +/- 9.98) degrees. When compared with preoperative X-ray film, statistically significant differences (P < 0.05) was found, but there was no statistically significant differences (P > 0.05) when compared with normal X-ray film. According to the American Orthopedic Foot and Ankle Society evaluation system for ankle-hind foot, 3 feet scored 60-70 points, 10 feet 70-80 points, 12 feet 80-90 points and 3 feet 90-100 points.
Conclusion: Allograft bone transplantation is an option for management of DIACFs, because it enables satisfactory reconstruction of bone defects, allows met anatomic reduction and functional recovery, maintaining restoration of calcaneal height and anatomic reduction of the posterior facet.