Prospective study of fracture calcaneus with Allan’s procedure- bone grafting without implants
Keywords:Intra-articular calcaneal fracture, Morbidity, Bone grafting, Functional outcome
Background: Calcaneum is usually fractured following high energy axial traumas such is seen in cases of fall from height or road traffic accidents. If not properly managed these fractures can be a cause of prolonged morbidity in the form of pain, stiffness and deformities. We have conducted this prospective study of fracture calcaneum with the method described by Allan et al which constitute of open reduction and bone grafting without any implants. The objective of the was to determine the clinical approach, described by Allan et al for treatment of fracture calcaneum and to discuss in short the results, pitfalls and challenges associated with this.
Methods: A prospective study was done on 42 patients who were diagnosed with intra-articular calcaneal fractures depending upon a predefined inclusion and exclusion criteria. All fractures of the study subjects were treated using a lateral approach by Allan’s procedure. Final outcome was assessed on the basis modified Rowe score.
Results: In this study a total of 42 patients with intra-articular calcaneal fractures and treated by open reduction and bone grafting without any implants were studied. There were 36 men and 6 women. Majority of the patients tolerated the procedure well and most of the patients (95.23%) had a complete or partial restoration of heel shape. Significant residual pain was seen in only 1 (2.38 %) patient. 36 patients (85.71 %) had excellent outcome 5 patients (11.90%) had good and 1 patient (2.38%) had satisfactory outcome.
Conclusions: The management of intra-articular calcaneal fracture by open reduction and bone grafting without any implants give good results with excellent functional outcome. Since no implants are used in this technique this can be a preferable procedure in rural areas and in patients with low socioeconomic status.
Gougoulias N, Khanna A, McBride DJ, Maffulli N. Management of calcaneal fractures: systematic review of randomized trials. Br Med Bull. 2009;92:153-67.
Born CT, Tahernia AD. Imaging of calcaneal fractures. Clin Podiatr Med Surg. 1997;14(2):337-56.
Lim EV, Leung JP. Complications of intraarticular calcaneal fractures. Clin Orthop Relat Res. 2001;(391):7-16.
Li Y, Bao RH, Jiang ZQ, Wu HY. Complications in operative fixation of calcaneal fractures. Pakistan J Med Sci. 2016;32(4):857-62.
Rak V, Ira D, Masek M. Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications. Indian J Orthop. 2009;43(3):271-80.
Allan JH. The Open Reduction of Fractures of the Os Calcis. Annals Surg. 1955;141(6):890-900.
Lamichhane A, Mahara D. Management of intra-articular fracture of calcaneus by combined percutaneous and minimal internal fixation. J Nepal Health Res Counc. 2013;11(23):70-5.
Randle JA, Kreder HJ, Stephen D, Williams J, Jaglal S, Hu R. Should calcaneal fractures be treated surgically: a meta-analysis. Clin Orthop. 2000;377:217-27.
Bridgeman SA, Dunn KM, McBride DJ, Richards PJ. Interventions for treating calcaneal fractures. Cochrane Database Syst Rev. 2002;2:Cd001161
Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ. 2014;349:4483.
Zeman P, Zeman J, Matejka J, Koudela K. Long-term results of calcaneal fracture treatment by open reduction and internal fixation using a calcaneal locking compression plate from an extended lateral approach. Acta Chir Orthop Traumatol Cech. 2008;75(6):457-64.
Loucks C, Buckley R. Bohler's angle: correlation with outcome in displaced intra-articular calcaneal fractures. J Orthop Trauma. 1999;13(8):554-8.
Catani F, Benedetti MG, Simoncini L. Analysis of function after intra-articular fracture of the os calcis. Foot Ankle Int. 1999;20:417-21.
Benirschke SK, Sangeorzan BJ. Extensive intraarticular fractures of the foot. Surgical management of calcaneal fractures. Clin Orthop Relat Res. 1993;(292):128-34.
Nouraei MH, Moosa FM. Operative compared to non-operative treatment of displaced intra-articular calcaneal fractures. Journal of Research in Medical Sciences. Official J Isfahan Univ Med Sci. 2011;16(8):1014-9.
Leung KS, Yuen KM, Chan WS. Operative treatment of displaced intra-articular fractures of the calcaneum. Medium-term results. J Bone Joint Surg Br. 1993;75(2):196-201.
Aldridge JM 3rd, Easley M, Nunley JA. Open calcaneal fractures: results of operative treatment. J Orthop Trauma. 2004;18(1):7-11.
Kundel K, Funk E, Brutscher M, Bickel R. Calcaneal fractures: operative versus nonoperative treatment. J Trauma. 1996;41:839-45.
Kennedy JG, Jan WM, McGuinness AJ, Barry K, Curtin J, Cashman WF, et al. An outcomes assessment of intra-articular calcaneal fractures, using patient and physician’s assessment profiles. Injury. 2003;34:932-6.
Buckley RE, Meek RN. Comparison of open versus closed reduction of intraarticular calcaneal fractures: a matched cohort in workmen. J Orthop Trauma. 1992;6:216-22.