FUNCTIONAL AND RADIOLOGICAL OUTCOMES OF DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURES MANAGED WITH LOCKING CALCANEAL PLATING WITH VERSUS WITHOUT BONE GRAFT: A PROSPECTIVE COMPARATIVE STUDY

Abstract

Background: The role of bone grafting in conjunction with locking calcaneal plating for displaced intra-articular calcaneal fractures (DIACFs) remains contested. Modern locked implants provide improved angular stability, raising the question of whether routine bone grafting confers additional functional or radiological benefit. This study prospectively compared outcomes of calcaneal plating with versus without bone graft in Sanders Type II and III fractures. Materials and Methods: Thirty patients with DIACFs managed operatively at a tertiary care teaching hospital between March 2024 and September 2025 were enrolled in this prospective comparative study. Group A (n = 15) underwent open reduction and internal fixation (ORIF) with locking calcaneal plating and iliac crest autograft bone graft; Group B (n = 15) underwent ORIF without bone graft. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score at 2 weeks, 2 months, and 6 months. Radiological parameters evaluated included Böhler’s angle and Gissane’s angle at each follow-up interval. Complications were documented throughout. Results: Both groups demonstrated significant postoperative improvement in Böhler’s angle (Group A: 7.8°4.2° to 30.6°3.8°; Group B: 8.1°3.9° to 29.8°4.1°) and correction of Gissane’s angle, with no significant intergroup difference at immediate postoperative assessment (p = 0.52 and p = 0.41, respectively). At final follow-up, Böhler’s angle maintenance was marginally superior in Group A (29.2°3.5° vs 27.4°4.3°; p = 0.04). Mean AOFAS scores at 6 months were 91.4 in Group A and 88.6 in Group B (p > 0.05). Mean operative time was longer in Group A (88.2 ± 4.2 min vs 84.6 ± 3.8 min; p = 0.09). Complication rates were comparable between groups. Conclusion: Locking calcaneal plating yields satisfactory functional and radiological outcomes in DIACFs with or without bone grafting. Bone graft offers a marginal advantage in maintaining Böhler’s angle in comminuted Sanders Type III fractures but does not confer a significant functional benefit overall. A selective, fracture-severity-guided approach to bone grafting is recommended over routine use.