Original Research
Allografts versus Equine Xenografts in Calcaneal Fracture Repair

https://doi.org/10.1053/j.jfas.2017.01.015Get rights and content

Abstract

Displaced intra-articular calcaneal fractures are difficult to treat. We determined the functional results and complications of using allografts or equine xenografts in treating these fractures. We reviewed patients seen at our center from May 2011 to December 2014 with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and an additional bone allograft or equine xenograft. A minimum of 1 year after surgery, a history of infection and functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society clinical rating system. Changes in the Gissane angle (GA) and Böhler angle were assessed from radiographs. Of the 91 eligible patients, 15 were lost to follow-up, leaving a sample of 76 patients (42 males): 45 received allografts (19 for type III and 26 for type IV fractures) and 31 received xenografts (20 for type III and 11 for type IV fractures). The mean age was about 40 years in both groups. After ≥1 year of follow-up, the proportion of patients in the American Orthopaedic Foot and Ankle Society scoring categories did not differ significantly between the 2 groups (mean ankle score, 86.5 in the allograft group and 85.1 in the xenograft group), and the American Orthopaedic Foot and Ankle Society functional outcomes were good or excellent in 69% and 68%, respectively (p = .986). The groups did not differ in the incidence of superficial or deep infection (p = 1.000). The Böhler angles were significantly decreased in the xenograft group. Xenografts might be preferred for repairing intra-articular calcaneal fractures because they can perform as well as allografts, avoid donor site morbidities, and are more available and less expensive than allografts.

Section snippets

Patients and Methods

The investigators' institutional review board approved the study. All patients provided written informed constant to participate. A retrospective search of the medical records of all patients presenting to the Ministry of Health's training and research hospital from May 2011 to December 2014 with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and additional bone grafting was done by 2 of us (M.M.S., M.U.).

The inclusion criteria for entry into the study

Results

A total of 91 patients were found who met all the inclusion criteria. Of the 91 patients, 15 were lost to follow-up, leaving a sample of 76 patients (Table 1). Of the 76 patients, 44 (57.9%) had Sanders type III fractures and 32 (42.1%), type IV fractures. All fractures were the result of high-energy trauma; 39 patients (51.3%) had additional associated injuries.

In 60 of the 76 patients (78.9%), the wounds healed primarily. Superficial defects and infections (wound edge necrosis and injuries to

Discussion

In our study, the functional and efficacy outcomes were similar between the 2 groups 1 year after surgery. The high healing potential and cancellous bone structure of the calcaneus could be main factors in the bone healing process.

The median difference between the preoperative and last follow-up measurements was not significant for the GA values in the xenograft group or the allograft group. However, the median difference between the preoperative and last follow-up measurements was significant

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    Conflict of Interest: None reported.

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