ObjectiveTo investigate the effectiveness of simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique.MethodsBetween January 2014 and August 2020, 6 cases of traumatic calcaneal osteomyelitis with defect deformities were treated by simultaneous treatment of near-arc bone transport by Ilizarov technique. The patients were all male; aged from 40 to 61 years (mean, 49.3 years). The disease duration was 2-72 months, with an average of 16.1 months. All patients were traumatic calcaneal osteomyelitis, including 4 cases of falling from height, 1 case of traffic accident injury, and 1 case of crushing injury. The infection affected the talar-heel joint in 4 cases, and the talar-heel joint was fused or partially fused in 2 cases. After the external fixator was removed, the Maryland foot scoring system was used to evaluate the foot function, and the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot function scoring system was used to evaluate the ankle-hindfoot function, and were compared with the preoperative scores.ResultsAll patients were followed up 1.5-26.0 months, with an average of 16.3 months. All incisions healed by first intention, no recurrence of infection occurred, and no surgical intervention such as second-stage bone grafting and fusion was performed. Five cases of calcaneal osteomyelitis with defect deformity underwent one-stage osteotomy and slipped, 1 case of the original bone mass after debridement after infection of calcaneal fractures slipped directly. The bone sliding time was 28-62 days, with an average of 38.7 days; the sliding distance was 3.1-5.2 cm, with an average of 3.6 cm. In 1 patient, due to the short follow-up time, the calcaneal slip bone had not healed, the external fixator had not been removed (not involved in clinical scoring), but the foot shape, reexamination of X-ray films and with frame walking were satisfactory. The time with external fixator was 6-8 months, with an average of 6.5 months in the other 5 cases. After removing the external fixator, the foot returned to three-point weight-bearing, and the longitudinal arch was recovered to varying degrees, and there was no obvious varus valgus. The Maryland score after removal of the external fixator was 80.8±4.7, which was significantly higher than that before operation (33.6±4.3) (t=–35.782, P=0.000), 3 cases were excellent and 2 cases were good; the median AOFAS ankle-hindfoot score was 84, the interquartile range was (79, 86), which was significantly improved when compared with the preoperative score [the median score was 33.5, the interquartile range was (21.3, 37.5)] (Z=–2.023, P=0.043), 4 cases were excellent and 1 case was good. Among them, pain, walking distance, getting rid of walking aids, going up and down stairs, deformity, etc. were significantly improved when compared with preoperative ones. Mobility such as subtalar and hock joints were poor or disappeared.ConclusionSimultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique can optimize the operation method, reduce the number of operations, and try to simulate the original shape of the calcaneus. It is an effective, economical, and novel treatment method.
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.