Temporal comparison of radiological and functional outcomes in calcaneal fracture surgery with and without iliac crest graft application: Mid- to long-term results

Abstract Background The standard approach for addressing intra-articular calcaneal fractures involves open reduction with plate and screw fixation, with ongoing discourse regarding the application of grafts to address bone gaps. The aim of this study is the temporal comparison of the radiological and functional outcomes in patients undergoing surgery for intra-articular calcaneal fractures, with a specific focus on the use of bone grafts. Methods Thirty patients, comprising 13 with iliac grafts and 17 without, were enrolled in the study. Preoperative and postoperative assessments included Gissane and Böhler angles, Visual Analog Scale (VAS) scores, American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scale, and Kellgreen-Lawrance subtalar arthrosis stages. The average follow-up period was 6.7 years, ranging from a minimum of 3.5 to a maximum of 10 years. Results The Böhler angle exhibited a significant increase ( p < 0.001), while the Gissane angle did not show significant changes in the early postoperative period across the entire study group ( p = 0.1). Graft-treated patients demonstrated a significantly higher Böhler angle in the early and late postoperative periods compared to preoperative values ( p = 0.04, p = 0.05). Similarly, patients without grafts exhibited a significantly higher Böhler angle in the early and late postoperative periods compared to preoperative values ( p = 0.004, p = 0.002). No significant differences were observed between periods in Gissane measurements ( p = 0.3), VAS scores, AOFAS scores, and the development of subtalar arthrosis in both grafted and non-grafted patients. Conclusions Evaluation of patients with calcaneal fractures, both with and without grafts, was conducted using Böhler and Gissane angles, VAS scores, AOFAS scores, and the development of fracture union and subtalar arthrosis, assessing preoperative, early, and late postoperative periods. No significant differences were found between the two groups in terms of clinical and radiological outcomes during mid-to long-term follow-up. Level of evidence A retrospective cohort study.