Structural versus morselized bone allograft in displaced intra-articular calcaneal fractures: A comparative retrospective study

A BSTRACT Objectives: Intra-articular calcaneal fractures are common in patients with high-energy trauma. Anatomical reduction is the key for optimal clinical and functional outcomes. Thus, how to avoid articular collapse is critical. Materials and Methods: The outcomes of using strut or morselized allografts for intra-articular calcaneal fractures were compared. We retrospectively enrolled 92 patients with a total of 101 calcaneal fractures. The mean follow-up duration was 18.4 months. Thirty-four fractures were reconstructed with strut allografts, and 67 fractures were reconstructed with morselized allografts. Böhler angle, Gissane angle, calcaneal height, width, and length were recorded after surgery, 3 months postoperatively, and at the final follow-up. The Visual Analog Scale (VAS) score, the American Orthopedic Foot and Ankle Society Ankle–Hindfoot Scale (AOFAS-AHS), and Short Form-12 (SF-12) Health Survey were documented preoperatively and at the final follow-up. Results: The VAS score, AOFAS-AHS, and SF-12 final follow-up at postoperative 1 + years were all improved significantly compared with preoperative assessment in both groups. However, the strut group exhibited a better ability to maintain Böhler angle, Gissane angle, and calcaneal height and a significant improvement compared to preoperative status ( P < 0.05), whereas the morselized group showed a significant collapse of Böhler angle, Gissane angle, and calcaneal height, especially at postoperative 3 months. Conclusion: This study exhibits that surgical intervention with a well-defined shaped, size-matched strut bone allograft provided stout strength for biomechanical support and achieved an improved functional outcome for intra-articular collapsed calcaneal fractures.