[Personalized reconstruction of post-traumatic calcaneal osteomyelitis with deformity using Ilizarov technique: a...

To summarize the clinical experiences of personalized reconstruction using Ilizarov technique for the treatment of 7 patients with post-traumatic calcaneal osteomyelitis and deformity.

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.

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.

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.