Functional Outcomes Comparing Open Reduction and Internal Fixation With and Without Bone Graft Substitute for Sanders Type III Calcaneus Fractures.

Abstract

Sanders Type III fractures of the calcaneus present a challenging injury often treated with open reduction and internal fixation (ORIF). The benefit of adding bone graft substitutes to enhance healing and outcomes remains uncertain. To compare the clinical and radiological results of ORIF performed with versus without the use of bone graft substitutes in patients with Sanders Type III calcaneal fractures. A prospective cohort study. Fifty adult patients diagnosed with Sanders Type III calcaneal fractures were prospectively divided into two groups. Group 1 received ORIF combined with bone graft substitute implantation, while Group 2 underwent ORIF alone. Radiographic evaluation involved measuring Bohler's and Gissane's angles preoperatively and at intervals immediately post-surgery, 3 months, and 6 months afterward. Functional outcomes were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Both groups showed marked improvement in Bohler's and Gissane's angles postoperatively (p < 0.05). Functional scores improved over time with no significant difference in AOFAS hindfoot scores between groups at 6 months (p > 0.05). Patients treated with bone graft substitutes reported more early postoperative discomfort and serous wound discharge. Although bone graft substitutes may assist in filling bone voids and provide initial mechanical support, their routine use may not be required for satisfactory outcomes when stable fixation is achieved in Sanders Type III calcaneal fractures.