SRS cancellous bone cement augmentation of galcaneal fracture fixation

Background. The proper treatment of intraarticular calcaneal fractures remains controversial. The goal of operative treatment is to achieve anatomic reduction with stable internal fixation. One method for stabilizing fracture constructs is the use of calcium phosphate bone cement. The goal of this study was to evaluate a series of patients who had open reduction and internal fixation of intra-articular calcaneal fractures with calcium phosphate bone cement augmentation. Methods: Fifteen patients had open reduction and internal fixation through an extensile lateral approach with standard low-profile hardware. The walls of the bone defect beneath the posterior facet were impacted with a curette and the void filled with SRS bone cement. Preoperative and postoperative plain radiographs and computed tomography (CT) were obtained on each patient. The most recent radiographs were assessed for maintenance of reduction. Results: Nine patients were followed for an average of 13 (6 to 60) months. Six patients had less than 6 months followup. There were five type IIA, five type IIB, four type IIC, and one type IIIB-C fractures. All 15 fractures were noted on postoperative CT to have less than 2-mm of step-off with complete cement fill of the bony void. None of the patients developed a soft-tissue reaction to the cement. The first six patients were allowed to bear weight 6 weeks after injury, and the following nine patients were allowed to bear weight at 3 weeks after injury. No patient had any visible loss of reduction on most recent radiographs. Followup CT at 7 months in one patient and 12 aid 51 months in another patient revealed no change in the bone-cement interface or amount of cement remaining. One patient's CT at 12 months revealed apparent fragmentation of the cement mass without loss of reduction. There was one major wound complication necessitating cement and hardware removal and free flap coverage. Conclusion: In this small series, patients had no evidence of soft-tissue reaction or loss of reduction with early weightbearing after open reduction and internal fixation augmented with calcium phosphate bone cement.