Assessment of the curative effects of open reduction and internal fixation with bone grafting on calcaneal displaced intra-articular fractures

Objective: The aim of this study was to compare the curative effects between open reduction and internal fixation with bone grafting and non-surgical treatment of calcaneal displaced intra-articular fractures. Methods: Data concerning 113 patients with closed calcaneal fractures, treated in Dongying People’s Hospital from February 2011 to January 2013, were retrospectively analyzed. Specifically, there was complete follow up data for 79 of the patients, in accord with inclusion criteria. Patients were divided into two groups based on different modes of treatment, including 37 cases in the surgical treatment group and 42 cases in the non-surgical treatment group. After treatment, patients were followed up in the clinic and Imaging Department for at least five years, until January 12, 2018. Patient foot function recovery was assessed with ankle hindfoot scores of American Orthopaedic Foot & Ankle Society (AOFAS). Bohler and Gissane angles were measured by reexamining lateral X-ray films of calcaneus. Post-treatment near-term complications (incision infections or necrosis of surrounding skin and plantar fascial compartment syndrome) and long-term complications (subtalar arthritis) were recorded in detail. Results: Differences between the baseline data (sex ratio, age, Sanders typing, Bohler angle, Gissane angle, injury cause, etc.) of the two groups of patients were not statistically significant (all P>0.05). One year after treatment and at the time of last follow up, the surgical group’s Bohler and Gissane angles were superior to those of the non-surgical group, with statistically significant differences (all P<0.05). One year after treatment and at the time of last follow up, AOFAS ankle hindfoot scores of both groups increased compared with those upon admission, with statistically significant differences (all P<0.05). Moreover, AOFAS scores of the surgical group were higher than the non-surgical group, with statistically significant differences (P<0.05). The surgical group’s near-incision infection or necrosis of surrounding skin incidence was 29.73%, while the non-surgical group’s plantar fascial compartment syndrome incidence was 7.14%. Differences were statistically significant (both P<0.05). At the time of last follow up, the non-surgical group’s subtalar arthritis incidence was obviously higher than the surgical group (45.24% vs. 21.62%), with statistically significant differences (P<0.05). The surgical group’s incision infections or necrosis of surrounding skin underwent anti-infection or flap transposition repair, with all incisions undergoing primary healing. Incidence of plantar fascial compartment syndrome in the non-surgical group was 7.14%. Patient conditions improved after the plantar fasciotomy was carried out, with no significant impact on overall curative effects. Conclusion: Open reduction and internal fixation with bone grafting can restore the smoothness of articular calcaneal surface as well as the height and length of calcaneus. They can prevent the bulging of compacted calcaneus towards both sides, reduce traumatic subtalar arthritis incidence after calcaneal displaced intra-articular fractures, and improve patient foot function.