Surgical treatment of infectious severe calcaneal bone defects in children by the Ilizarov technique
Qiyue Zhang1, Aierken Rehemutula1, Maimaitiyiming Maitudi2
1Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Afliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
Insights
The Ilizarov technique effectively reconstructs calcaneal bone defects in children, restoring normal walking ability. This method significantly improves foot function and daily living activities post-treatment.
Area of Science:
- Pediatric Orthopedics
- Bone Reconstruction
- Infectious Bone Defects
Background:
- Calcaneal bone defects in children, often post-infection, impair normal walking.
- Reconstruction of the calcaneus presents significant challenges.
- The Ilizarov technique is explored for treating these defects.
Purpose of the Study:
- To evaluate the methodology of the Ilizarov technique for calcaneal infectious bone defects.
- To assess the clinical outcomes of the Ilizarov technique in pediatric patients.
- To determine the efficacy of Ilizarov technique in bone lengthening for calcaneal reconstruction.
Main Methods:
- Retrospective analysis of 12 pediatric cases treated with the Ilizarov technique (Jan 2018 - Aug 2022).
- Procedures included calcaneal stump lengthening (9 cases) or talus lengthening (3 cases).
- Radical debridement and bone lengthening were performed, with 2 cases using drug-loaded bone cement spacers.
Main Results:
- Bone lengthening averaged 3.57 cm over 41.75 days.
- Significant reduction in inflammation markers (CRP, ESR, IL-6) post-debridement (p < 0.01).
- Improved pain scores, foot function, self-care, and hind foot function; all patients returned to normal life.
Conclusions:
- The Ilizarov technique is effective for large infectious calcaneal bone defects and bone lengthening.
- This method reconstructs calcaneal bone function without significant ankle joint impact.
- Successful functional restoration enables children to return to normal activities.
Introduction:
The soft tissue of the heel is weak, and calcaneal bone defects occur easily post-infection, resulting in the inability of paediatric patients to walk normally. Calcaneal reconstruction is challenging. We aimed to evaluate the methodology and clinical effects of the Ilizarov technique in the treatment of calcaneal infectious bone defects.
Methods:
We retrospectively analyzed the cases of 12 children with infectious calcaneal bone defects treated by the Ilizarov technique in our center from January 2018 to August 2022.Stump lengthening of the calcaneus was performed in nine cases. Due to severe calcaneus infection the calcaneus was removed, and talus lengthening was performed in three children. Two children were treated with drug-loaded spacer bone cement to control peripheral soft tissue infection before bone elongation could be performed, while the other ten cases underwent bone lengthening at one stage after radical debridement. Pain, foot function, self-care ability and hind foot function were evaluated using a Visual Analogue Scale (VAS), the Maryland Foot Score, Activity of Daily Living scale, and the American Orthopaedic Foot and Ankle Society retro ankle foot score.
Results:
In this cohort of 12 children, the time for bone lengthening ranged from 32 to 64 days (mean 41.75 ± 10.09 days), and the distance of bone lengthening was between 2.6 cm and 5.4 cm (mean 3.57 ± 0.86 cm). The inflammation indicators CRP, ESR, and IL-6 were significantly reduced after radical debridement (15.72 ± 3.09 vs 6.04 ± 1.28, 25.20 ± 2.72 vs 15.11 ± 1.56, 16.39 ± 3.75 vs 2.99 ± 1.08, respectively; p < 0.01). Bone reconstruction effectively reduced pain in the affected limb and significantly improved foot function, self-care ability, and hind foot function in these children. In four cases, external fixators were removed and an Achilles tendon lengthening operation was performed to further reconstruct calcaneal bone function. After surgical treatment, all the children in this cohort were able to return to normal life.
Conclusion:
The Ilizarov technique for treating large infectious calcaneal bone defects and bone lengthening can effectively reconstruct the function of the calcaneal bone without significantly affecting the ankle joint.
