Surgical treatment of calcaneal fractures with use of β-tricalcium phosphate ceramic grafting

Background: The treatment of calcaneal fractures is challenging. Internal fixation and grafting with sintered beta-tricalcium phosphate (beta-TCP) ceramic is alternative to bone grafting in the treatment of calcaneal fractures. Methods: Seventy-four patients with intraarticular calcaneal fractures were treated with open reduction, internal fixation and grafting with sintered beta-TCP ceramic. Followup was performed using the Maryland foot score as well as plain radiography. Results: All patients were followed for 15 (range, 12 to 26) months. Clinical results as assessed by the Maryland foot score were excellent in 40 of 74 cases (54.1%), good in 28 (37.8%), and fair in 6 (8.1%). Immediately after surgery, the mean Bohler angle was improved by 23 degrees, and I year after surgery, the mean Bohler angle decreased by 4 degrees. A similar change was also seen in Gissane angles and the height and width of the calcaneus. There was no statistical correlation between the severity of fracture and functional outcome in this series. All fractures healed. Conclusion: These findings suggest that use of beta-TCP combined with open reduction and internal fixation is an effective and safe method for the surgical treatment of intra-articular calcaneal fractures.