Journal List > J Korean Foot Ankle Soc > v.21(1) > 1043438

Bang, Bae, Woo, and Chung: Tricortical-allobone Grafting in Screw Fixation for Intra-articular Calcaneal Fracture via Ollier Approach



Bone grafting is often necessary to maintain a reduction and prevent delayed collapse of reduced fracture in a treatment of severely displaced comminuted intra-articular calcaneal fractures. Herein, we analyzed the usefulness and necessary conditions to perform tricortical-allobone grafting in open reduction of calcaneal fracture via the Ollier approach.

Materials and Methods:

We performed a retrospective review of 57 intra-articular calcaneal fractures that underwent an operation via the Ollier approach between April 2009 and April 2015. They were divided into two groups: Group 1 (n=17) included those with tricor-tical-allobone grafts underneath the posterior facet fragment, and group 2 (n=40) included cases without a bone graft. We measured the Böhler angle, Gissane angle, height, and width of the calcaneus at preoperative, postoperative, and final follow-up radiograph. We measured the sagittal rotational angle of the posterior facet fragment of preoperative computed tomography to analyze the effect and necessary conditions for bone grafting. We also reviewed the clinical results by the American Orthopaedic Foot and Ankle Society (AOFAS) scale, visual analogue scale (VAS), and any complications.


According to the Sanders classification, there were 3 type-II fractures, 12 type-III fractures, and 2 type-IV fractures in Group 1; whereas in Group 2, there were 26 type-II fractures, 13 type-III fractures, and 1 type-IV fracture (p=0.002). Regarding the preoperative radiologic parameters, there were significant differences in the Böhler angle (p=0.006), Gissane angle (p=0.043), and rotational angle of the posterior facet fragment (p=0.001). No significant difference was observed in the preoperative calcaneal height and width, as well as postoperative radiologic parameters. There was no significant clinical difference between the two groups (p=0.546).


We suggest that a tricortical-allobone graft may be useful in open reduction and screw fixation via the Ollier approach for displaced intra-articular calcaneal fracture with a bony defect after reduction of collapsed posterior facet fragment. This graft can contribute to the stable reduction via a small approach, even without a plate.


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Figure 1.
Fixation with screws and grafting with tricortical-allobone. Lateral view (A) and axial view (B) of radiographs.
Figure 2.
Posterior facet fragment rotation angle.
Figure 3.
Tricortical-allobone graft.
Table 1.
Operative Information on the Patients in the Two Groups
General information Group 1 (n=17) Group 2 (n=40) p-value
Sex 0.002
Male 9 (52.9) 36 (90.0)
Female 8 (47.1) 4 (10.0)
Age (yr) 54.2±10.8 52.6±14.5 0.118
Affected side (%) 0.707
Right 9 (52.9) 19 (47.5)
Left 8 (47.1) 21 (52.5)
Injury mechanism 0.720
Fall down 11 (64.7) 30 (75.0)
Slip down 5 (29.4) 8 (20.0)
Traffic accident 1 (5.9) 2 (5.0)
Essex-Lopresti classification 0.313
Tongue 5 (29.4) 7 (17.5)
Joint depression 12 (70.6) 33 (82.5)
Sanders classification 0.002
Type IIA 1 (5.9) 18 (45.0)
Type IIB 1 (5.9) 7 (17.5)
Type IIC 1 (5.9) 1 (2.5)
Type IIIAB 6 (35.3) 12 (30.0)
Type IIIAC 6 (35.3) 1 (2.5)
Type IIIBC 0 0
Type IV 2 (11.8) 1 (2.5)
Time from injury to operation (day) 3.5±4.6 2.8±2.6 0.134
Follow-up periods (mo) 9.2±7.6 12.5±9.3 0.198

Values are presented as number (%) or mean±standard deviation. Group 1: using tricortical-allobone graft, Group 2: not using tricortical-allobone graft.

Table 2.
Preoperative, Immediate Postoperative, Final Follow-up Radiologic Measurements
Parameter Group 1 (n=17) Group 2 (n=40) p-value
Böhler angle (°)
Preoperative 1.5±10.2 9.7±9.7 0.006
Postoperative 20.8±6.3 22.5±6.0 0.324
Final 16.4±9.8 20.9±6.9 0.056
Gissane angle (°) Preoperative 117.4±17.5 107.6±10.9 0.043
Postoperative 106.5±13.3 102.9±8.3 0.209
Final 110.1±14.5 106.0±9.1 0.296
Calcaneal height (mm)
Preoperative 42.6±4.7 45.9±3.5 0.065
Postoperative 45.5±4.3 48.3±3.4 0.132
Final 44.4±3.3 47.2±3.8 0.191
Calcaneal width (mm)
Preoperative 47.6±4.7 46.2±5.0 0.324
Postoperative 42.2±4.4 41.6±3.4 0.607
Final 42.4±3.9 41.5±3.8 0.438
Preoperative posterior facet fragment rotation angle (°)
Preoperative 29.3±13.4 10.9±9.8 0.001

Values are presented as mean±standard deviation. Group 1: using tricortical-allobone graft, Group 2: not using tricortical-allobone graft.

Table 3.
Clinical Results at Final Follow-up
Assessment Group 1 (n=17) Group 2 (n=40) p-value
AOFAS scale 87.3±9.4 86.7±8.8 0.546
VAS score 2.2±1.2 2.1±1.4 0.576

Values are presented as mean±standard deviation. Group 1: using tricortical-allobone graft, Group 2: not using tricortical-allobone graft. AOFAS: American Orthopaedic Foot and Ankle Society, VAS: visual analogue scale.

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