Personalized reconstruction of post-traumatic calcaneal osteomyelitis with deformity using Ilizarov technique: a report of seven cases_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Lei ¹ , HUA Haotian ² ,  WANG Xinwei ¹ , WU Xiaolong ¹ , CHEN Yusheng ³ , XING Linbo ¹ , ZHANG Li ¹ , LI Youyou ¹ , CHEN Jiangfei ¹

1. Department Ⅱ of Bone and Joint Infection, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Orthopedic Hospital), Luoyang Hennan, 471002, P. R. China;
2. Department of Orthopedic and Traumatological Surgery, Suzhou Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine, Suzhou Jiangsu, 215000, P. R. China;
3. Department of Plastic Surgery, the Second Hospital Affiliated to Henan University of Science Technology, Luoyang Hennan, 471000, P. R. China;

Corresponding?author：

WANG Xinwei, Email: 786168995@qq.com

Keywords：

Calcaneal deformity; osteomyelitis; external fixator; bone transport; Ilizarov technique

DOI：

10.7507/1002-1892.202602039

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Objective To summarize the clinical experiences of personalized reconstruction using Ilizarov technique for the treatment of 7 patients with post-traumatic calcaneal osteomyelitis and deformity. Methods Between January 2014 and January 2022, 7 patients with post-traumatic calcaneal osteomyelitis and deformity were treated. All patients were male, with a mean age of 45.4 years (range, 27-61 years). The duration of osteomyelitis ranged from 2 to 72 months (median, 6 months). Based on the extent of bone defect, deformity characteristics, and stability requirements of the hindfoot, personalized reconstructive strategies were designed using the Ilizarov technique. Of the 7 patients, 6 underwent in situ multiplanar trajectory bone transport reconstruction of the calcaneus, and 1 underwent tibial osteotomy with bone transport for replacement reconstruction due to talar infection and necrosis combined with extensive calcaneal defect. Postoperatively, X-ray films were performed regularly to evaluate the trajectory of the transported bone segment, bone contact, and mineralization of new bone; the external fixator configuration was adjusted according to the position of the bone segment and the requirements for deformity correction. Results All patients completed bone transport and successfully removed the external fixator. And all patients experienced 1-3 needle infections, which improved after symptomatic treatment. All incisions healed by first intention. All patients were followed up 6-60 months (mean, 36.5 months). In 6 patients who underwent in situ multiplanar trajectory bone transport reconstruction, the external fixator adjustment period ranged from 30 to 62 days (mean, 39.3 days), and the duration of external fixation ranged from 6 to 8 months (mean, 6.8 months). After removal of the external fixator, the 6 patients achieved a plantigrade foot, with varying degrees of improvement in calcaneal length, height, contour, and longitudinal arch. After fixator removal, the Maryland score was 78.8±4.4 and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score was 80.1±4.4; there were significant differences when compared with the preoperative scores (33.0±4.1, 30.7±8.4; P<0.001). In 1 patient who underwent tibial osteotomy with bone transport for replacement reconstruction, the external fixator adjustment period was 82 days, and the duration of external fixation was 13 months. After fixator removal, the patient was able to walk with full weight-bearing without pain. The Maryland score was 78 and the AOFAS ankle-hindfoot score was 77. Conclusion Multi-plane adjustment, flexibly combining straight, oblique, and curved planes with bone transport techniques, provide a comprehensive solution for the treatment of post-traumatic calcaneal osteomyelitis and deformity. These techniques offer advantages such as effective infection control, minimal trauma, adequate new bone formation, and gradual deformity correction, making them a valuable approach for calcaneal reconstruction.

Citation： ZHANG Lei, HUA Haotian, WANG Xinwei, WU Xiaolong, CHEN Yusheng, XING Linbo, ZHANG Li, LI Youyou, CHEN Jiangfei. Personalized reconstruction of post-traumatic calcaneal osteomyelitis with deformity using Ilizarov technique: a report of seven cases. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(9): 1399-1406. doi: 10.7507/1002-1892.202602039 Copy

1.	Eckardt H, Lind M. Effect of Intraoperative three-dimensional imaging during the reduction and fixation of displaced calcaneal fractures on articular congruence and implant fixation[J]. Foot Ankle Int, 2015, 36(7): 764-773.
2.	Roll C, Schirmbeck J, Muller F, et al. Value of 3D reconstructions of ct scans for calcaneal fracture assessment[J]. Foot Ankle Int, 2016, 37(11): 1211-1217.
3.	Gusic N, Fedel I, Darabos N, et al. Operative treatment of intraarticular calcaneal fractures: anatomical and functional outcome of three different operative techniques. Injury[J], 2015, 46(Suppl 6): S130-S133.
4.	Kim Y, Inori F, Yamanaka K, et al. A case of osteomyelitis after calcaneal fracture treature treated by antibiotic-containing calcium phosphate cements[J/OL]. Case Rep Orthop, 2018, 2018: 9321830. doi: 10.1155/2018/9321830.
5.	張波, 陳磊, 韓清鑾, 等. 3D打印輔助跟骨骨折畸形愈合手術重建的意義[J]. 中華骨與關節外科雜志, 2020, 13(7): 548-554.
6.	Simpson AH, Deskin M, Latiham JM. Chroic osteomyelitis. The effect of the extent of surgical resection on infection-free survival[J]. J Bone Joint Surg (Br), 2001, 83(3): 403-407.
7.	張磊, 陳雨聲, 王新衛, 等. Ilizarov 技術近弧形骨塊滑移同期治療創傷性跟骨骨髓炎并缺損畸形[J]. 中國修復重建外科雜志, 2021, 35(3): 323-329.
8.	Giannoudis PV, Harwood PJ, Tosounidis T, et al. Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes[J]. Injury, 2016, 47 Suppl 6: S53-S61.
9.	Imanishi J, Choong PFM. Three-dimensional printed calcaneal prosthesis following total calcanectomy[J]. Int J Surg Case Rep, 2015, 10: 83-87.
10.	Cai G, Liu W, Xiong JY, et al. Functional reconstruction of hindfoot with total calcaneus and talus loss by Ilizarov technique: a case report[J]. J Foot Ankle Surg, 2020, 59(1): 142-148.
11.	Kr?henbühl N, Horn-Lang T, Hintermann B, et al. The subtalar joint: A complex mechanism[J]. EFORT Open Reviews, 2017, 2(7): 309-316.
12.	趙建文, 龍承, 王曉偉, 等. 3D打印個體化鈦籠結合Masquelet技術治療跟骨感染性骨缺損[J]. 中華骨科雜志, 2020, 40(5): 310-316.
13.	Rasor ZL, Henning J, Blanton C, et al. Vertical wire forefoot fixation: an advanced technique for the dynamic external fixation apparatus[J]. J Foot Ankle Surg, 2019, 58(5): 1040-1044.
14.	張磊, 王新衛, 陳雨聲, 等. 結合 Ilizarov 技術行脛跟或脛距跟融合同期治療踝關節感染并骨缺損療效分析[J]. 中國修復重建外科雜志, 2017, 31(9): 1059-1063.
15.	Gan T, Li Y, Liu X, et al. Staged Ilizarov distraction histogenesis and corrective reconstruction for severe malunited calcaneal fractures[J]. Arch Orthop Trauma Surg, 2023, 143(6): 2845-2854.
16.	黃雷, 王慎東, 滕星, 等. 牽拉成骨技術結合脛距或脛跟融合術治療踝關節周圍感染性骨折不愈合[J]. 中華外科雜志, 2015, 53(6): 405-409.
17.	Zhang R, Yao X, Wang X, et al. Calcaneal lengthening after tarsal bone fusion for massive calcaneus defect reconstruction[J]. Orthop Surg, 2024, 16(9): 2211-2220.
18.	Cui R, Qiu X, Tan L, et al. External fixation with bone cement implantation for open calcaneal fractures: A case series[J]. Foot Ankle Surg, 2022, 28(2): 251-257.
19.	張來福, 盧承印, 王孝輝, 等. 3D打印輔助Masquelet膜誘導技術治療跟骨骨缺損的療效研究[J]. 創傷外科雜志, 2021, 23(7): 507-511.
20.	Park BY. Use of de-epithelialized free perforator flaps for simultaneous bone and soft-tissue reconstruction in chronic calcaneus osteomyelitis[J/OL]. Sci Rep, 2025, 15(1): 19264. doi: 10.1038/s41598-025-04007-2.
21.	楊曉勇, 徐永清, 徐曉燕, 等. 膜誘導技術聯合腓腸神經營養血管皮瓣治療跟骨創傷性骨髓炎合并軟組織缺損[J]. 中華顯微外科雜志, 2025, 48(1): 7-13.
22.	Zhang Q, Rehemutula A, Maitudi M, et al. Surgical treatment of infectious severe calcaneal bone defects in children by the Ilizarov technique[J/OL]. Injury, 2025, 56(4): 112224. doi:10.1016/j.injury.2025.112224.
23.	Osnach SA, Protsko VG, Obolenskiy VN, et al. Method of tibiocalcanealarthrodesis for a total defect of the talus in patients with Charcot neuroarthropathy[J]. Traumatology and Orthopedics of Russia, 2025, 31(1): 125-132.

1. Eckardt H, Lind M. Effect of Intraoperative three-dimensional imaging during the reduction and fixation of displaced calcaneal fractures on articular congruence and implant fixation[J]. Foot Ankle Int, 2015, 36(7): 764-773.
2. Roll C, Schirmbeck J, Muller F, et al. Value of 3D reconstructions of ct scans for calcaneal fracture assessment[J]. Foot Ankle Int, 2016, 37(11): 1211-1217.
3. Gusic N, Fedel I, Darabos N, et al. Operative treatment of intraarticular calcaneal fractures: anatomical and functional outcome of three different operative techniques. Injury[J], 2015, 46(Suppl 6): S130-S133.
4. Kim Y, Inori F, Yamanaka K, et al. A case of osteomyelitis after calcaneal fracture treature treated by antibiotic-containing calcium phosphate cements[J/OL]. Case Rep Orthop, 2018, 2018: 9321830. doi: 10.1155/2018/9321830.
5. 張波, 陳磊, 韓清鑾, 等. 3D打印輔助跟骨骨折畸形愈合手術重建的意義[J]. 中華骨與關節外科雜志, 2020, 13(7): 548-554.
6. Simpson AH, Deskin M, Latiham JM. Chroic osteomyelitis. The effect of the extent of surgical resection on infection-free survival[J]. J Bone Joint Surg (Br), 2001, 83(3): 403-407.
7. 張磊, 陳雨聲, 王新衛, 等. Ilizarov 技術近弧形骨塊滑移同期治療創傷性跟骨骨髓炎并缺損畸形[J]. 中國修復重建外科雜志, 2021, 35(3): 323-329.
8. Giannoudis PV, Harwood PJ, Tosounidis T, et al. Restoration of long bone defects treated with the induced membrane technique: protocol and outcomes[J]. Injury, 2016, 47 Suppl 6: S53-S61.
9. Imanishi J, Choong PFM. Three-dimensional printed calcaneal prosthesis following total calcanectomy[J]. Int J Surg Case Rep, 2015, 10: 83-87.
10. Cai G, Liu W, Xiong JY, et al. Functional reconstruction of hindfoot with total calcaneus and talus loss by Ilizarov technique: a case report[J]. J Foot Ankle Surg, 2020, 59(1): 142-148.
11. Kr?henbühl N, Horn-Lang T, Hintermann B, et al. The subtalar joint: A complex mechanism[J]. EFORT Open Reviews, 2017, 2(7): 309-316.
12. 趙建文, 龍承, 王曉偉, 等. 3D打印個體化鈦籠結合Masquelet技術治療跟骨感染性骨缺損[J]. 中華骨科雜志, 2020, 40(5): 310-316.
13. Rasor ZL, Henning J, Blanton C, et al. Vertical wire forefoot fixation: an advanced technique for the dynamic external fixation apparatus[J]. J Foot Ankle Surg, 2019, 58(5): 1040-1044.
14. 張磊, 王新衛, 陳雨聲, 等. 結合 Ilizarov 技術行脛跟或脛距跟融合同期治療踝關節感染并骨缺損療效分析[J]. 中國修復重建外科雜志, 2017, 31(9): 1059-1063.
15. Gan T, Li Y, Liu X, et al. Staged Ilizarov distraction histogenesis and corrective reconstruction for severe malunited calcaneal fractures[J]. Arch Orthop Trauma Surg, 2023, 143(6): 2845-2854.
16. 黃雷, 王慎東, 滕星, 等. 牽拉成骨技術結合脛距或脛跟融合術治療踝關節周圍感染性骨折不愈合[J]. 中華外科雜志, 2015, 53(6): 405-409.
17. Zhang R, Yao X, Wang X, et al. Calcaneal lengthening after tarsal bone fusion for massive calcaneus defect reconstruction[J]. Orthop Surg, 2024, 16(9): 2211-2220.
18. Cui R, Qiu X, Tan L, et al. External fixation with bone cement implantation for open calcaneal fractures: A case series[J]. Foot Ankle Surg, 2022, 28(2): 251-257.
19. 張來福, 盧承印, 王孝輝, 等. 3D打印輔助Masquelet膜誘導技術治療跟骨骨缺損的療效研究[J]. 創傷外科雜志, 2021, 23(7): 507-511.
20. Park BY. Use of de-epithelialized free perforator flaps for simultaneous bone and soft-tissue reconstruction in chronic calcaneus osteomyelitis[J/OL]. Sci Rep, 2025, 15(1): 19264. doi: 10.1038/s41598-025-04007-2.
21. 楊曉勇, 徐永清, 徐曉燕, 等. 膜誘導技術聯合腓腸神經營養血管皮瓣治療跟骨創傷性骨髓炎合并軟組織缺損[J]. 中華顯微外科雜志, 2025, 48(1): 7-13.
22. Zhang Q, Rehemutula A, Maitudi M, et al. Surgical treatment of infectious severe calcaneal bone defects in children by the Ilizarov technique[J/OL]. Injury, 2025, 56(4): 112224. doi:10.1016/j.injury.2025.112224.
23. Osnach SA, Protsko VG, Obolenskiy VN, et al. Method of tibiocalcanealarthrodesis for a total defect of the talus in patients with Charcot neuroarthropathy[J]. Traumatology and Orthopedics of Russia, 2025, 31(1): 125-132.

Chinese Journal of Reparative and Reconstructive Surgery

Personalized reconstruction of post-traumatic calcaneal osteomyelitis with deformity using Ilizarov technique: a report of seven cases

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