Midshaft tibial osteotomy and bone transport for tibiocalcaneal arthrodesis

Talar necrosis and infection present a significant challenge, frequently requiring talectomy, which transforms the tibiotalar joint into a tibiocalcaneal articulation. Key management uncertainties persist regarding the necessity of formal arthrodesis vs. the adequacy of a stable fibrous union, and the optimal method for concomitant limb length restoration. This study evaluates a technique combining minimally invasive midshaft tibial osteotomy with Ilizarov distraction osteogenesis to address tibiocalcaneal reconstruction and limb lengthening, seeking to inform these clinical decisions.

Twelve patients who underwent TC arthrodesis at the 920th Hospital of the PLA between January 2014 and July 2019 were included. The cohort consisted of 7 cases of talar infection following open fractures and 5 cases of tuberculous talar infection, all with partial or complete necrosis. Outcomes assessed included bone elongation, fusion rates, AOFAS ankle-hindfoot scores, and postoperative complications.

All patients were followed up for 1.5 to 4.5 years. The external fixation frame was maintained for an average of (3.04 ± 0.32) months. Bone transport ranged from 4.3 to 7.0 cm, with a mean of (5.88 ± 1.00) cm. Tibial-calcaneal fusion was achieved in 7 cases, while 5 cases exhibited pseudarthrosis; however, their daily activities were unaffected, and pain levels were mild. The average AOFAS score was (75.92 ± 3.73) postoperatively (p < 0.0001), indicating a marked enhancement in functional outcomes with no recurrent infections or postoperative complications.

This study highlights the role of minimally invasive midshaft tibial osteotomy in optimizing TC arthrodesis outcomes, achieving functional improvements even in cases of pseudarthrosis. Future research should focus on management protocols for pseudarthrosis to further enhance TC arthrodesis effectiveness.