Displaced Intra‑Articular Calcaneal Fractures Treated with Open Reduction and Internal fixation and Bone Void Filling with an Injectable Calcium Sulfate/Hydroxyapatite Bone Graft Substitute: A Series of 18 Patients

Abstract

Background: There is an ongoing debate if bone graft substitutes (BGSs) are beneficial in the treatment of displaced intra‑articular calcaneal<br /> fractures (DIACFs). The purpose of this study was to evaluate the effect of an injectable calcium sulfate/hydroxyapatite BGS (CERAMENTTM<br /> iBONE VOID FILLER, BONESUPPORT AB, Lund, Sweden) in internal fixation of calcaneal fractures. Methods: The records of patients<br /> presenting with calcaneal fractures type Sanders III and IV and treated with internal fixation plus BGS were reviewed. Radiographs were<br /> analyzed using different measurements (including Böhler's angle and calcaneal facet height). The clinical outcome was evaluated using the<br /> American Orthopaedic Foot and Ankle Society (AOFAS) Ankle‑Hindfoot Scale. Results: A total of 20 fractures were available for radiographic<br /> and clinical examination at a minimum follow‑up of 12 months. No decrease in Böhler's angle was recorded in six fractures, a reduction<br /> of <5° in 6 and of more than 5° in 8 fractures. In all fractures, the BGS was completely resorbed at 12 months on radiographs. The AOFAS<br /> score was on an average 89.8 (range, 68–99) at 1‑year follow‑up and indicated an excellent outcome in 11, a good outcome in 8, and a fair<br /> outcome in 1 fracture. Conclusions: The study results support the use of an injectable, in situ hardening calcium sulfate/hydroxyapatite BGS<br /> in DIACFs. The BGS is easy and safe to use as an augment to open reduction and internal fixation.