Displaced Intra‑Articular Calcaneal Fractures Treated with Open Reduction and Internal fixation and Bone Void Filling with an Injectable Calcium Sulfate/Hydroxyapatite Bone Graft Substitute: A Series of 18 Patients

Document Type: Original Article


1 Department of Orthopedic Surgery and Traumatology, Santa Chiara Hospital, Trento, Italy

2 Department of Radiology, Santa Chiara Hospital, Trento, Italy


Background: There is an ongoing debate if bone graft substitutes (BGSs) are beneficial in the treatment of displaced intra‑articular calcaneal
fractures (DIACFs). The purpose of this study was to evaluate the effect of an injectable calcium sulfate/hydroxyapatite BGS (CERAMENTTM
iBONE VOID FILLER, BONESUPPORT AB, Lund, Sweden) in internal fixation of calcaneal fractures. Methods: The records of patients
presenting with calcaneal fractures type Sanders III and IV and treated with internal fixation plus BGS were reviewed. Radiographs were
analyzed using different measurements (including Böhler’s angle and calcaneal facet height). The clinical outcome was evaluated using the
American Orthopaedic Foot and Ankle Society (AOFAS) Ankle‑Hindfoot Scale. Results: A total of 20 fractures were available for radiographic
and clinical examination at a minimum follow‑up of 12 months. No decrease in Böhler’s angle was recorded in six fractures, a reduction
of <5° in 6 and of more than 5° in 8 fractures. In all fractures, the BGS was completely resorbed at 12 months on radiographs. The AOFAS
score was on an average 89.8 (range, 68–99) at 1‑year follow‑up and indicated an excellent outcome in 11, a good outcome in 8, and a fair
outcome in 1 fracture. Conclusions: The study results support the use of an injectable, in situ hardening calcium sulfate/hydroxyapatite BGS
in DIACFs. The BGS is easy and safe to use as an augment to open reduction and internal fixation.


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