Simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Lei ¹ , CHEN Yusheng ² ,  WANG Xinwei ¹ , HUA Haotian ¹ , SHENG Jingya ¹ , CHEN Jiangfei ¹ , GUO Zairan ¹

1. No.1 Department of Osteomyelitis, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China;
2. Department of VIP, the Second Affiliated Hospital of Henan University of Science and Technology, Luoyang Henan, 471000, P.R.China;

Corresponding author：

WANG Xinwei, Email: 786168995@qq.com

Keywords：

Calcaneal osteomyelitis; trauma; bone defect deformity; Ilizarov technique

DOI：

10.7507/1002-1892.202010064

Video：

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Objective To investigate the effectiveness of simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique.Methods Between 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.Results All 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.Conclusion Simultaneous 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.

Citation： ZHANG Lei, CHEN Yusheng, WANG Xinwei, HUA Haotian, SHENG Jingya, CHEN Jiangfei, GUO Zairan. Simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(3): 323-329. doi: 10.7507/1002-1892.202010064 Copy

1.	Gitajn IL, Abousayed M, Toussaint RJ, et al. Anatomic alignment and integrity of the sustentaculum tali in intra-articular calcaneal fractures: Is the sustentaculum tali truly constant? J Bone Joint Surg (Am), 2014, 96(12): 1000-1005.
2.	Guerado E, Bertrand ML, Cano JR. Management of calcaneal fractures: what have we learnt over the years? Injury, 2012, 43(10): 1640-1650.
3.	Kim Y, Inori F, Yamanaka K, et al. A case of osteomyelitis after calcaneal fracture treature treated by antibiotic-containing calcium phosphate cements. Case Rep Orthop, 2018, (12): 1-4.
4.	Oliver NG, Steinberg JS, Powers K, et al. Lower extremity function following partial calcanectomy in high-risk limb salvage patients. J Diabet Res, 2015, (4): 432-164.
5.	Rasor ZL, Henning J, Blanton C, et al. Vertical wire forefoot fixation: An advanced technique for the dynamic external fixation apparatus. J Foot Ankle Surg, 2019, 58(5): 1040-1044.
6.	Oh EJ, Oh SH, Lee IS, et al. Antibiotic-eluting hydrophilized PMMA bone cement with prolonged bactericidal effect for the treatment of osteomyelitis. J Biomater Appl, 2016, 30(10): 1534-1544.
7.	Hamid KS, Parekh SG, Adams SB. Salvage of severe foot and ankle trauma with a 3D printed scaffold. Foot Ankle Int, 2016, 37(4): 433-439.
8.	秦泗河, 焦绍锋, 潘奇. Ilizarov 技术结合游离皮瓣移植治疗创伤后重度马蹄足畸形伴跟骨缺损一例. 中华创伤骨科杂志, 2013, 15(10): 919-920.
9.	Masquelet AC. Induced membrane technique: Pearls and pitfalls. J Orthop Trauma, 2017, 31 Suppl 5: S36-S38.36-38.
10.	Oh Y, Yoshii T, Okawa A. Ankle arthrodesis using a modified Masquelet induced membrane technique for open ankle fracture with a substantial osteochondral defect: A case report of novel surgical technique. Injury, 2019, 50(11): 2128-2135.
11.	Canavese F, Dimeglio A, Bonnel F. Postoperative CT-scan 3D reconstruction of the calcaneus following lateral calcaneal lengthening osteotomy for flatfoot deformity in children. Is the surgical procedure potentially associated with subtalar joint damage?. Foot Ankle Surg, 2018, 24(5): 453-459.
12.	蔡鸿敏, 倘艳锋, 李红军, 等. 保留髂嵴的髂骨翼取骨术. 中华骨科杂志, 2019, 39(10): 589-595.
13.	赵建文, 龙承, 王晓伟, 等. 3D 打印个体化钛笼结合 Masquelet 技术治疗跟骨感染性骨缺损. 中华骨科杂志, 2020, 40(5): 310-316.
14.	Cai G, Liu W, Xiong J, et al. Functional reconstruction of hindfoot with total calcaneus and talus loss by ilizarov technique: A case report. J Foot Ankle Surg, 2020, 59(1): 142-148.
15.	Hsu AR. Complex ankle and hindfoot arthrodesis using circular external fixation. Am J Orthop (Belle Mead NJ), 2018, 47(9). doi: 10.12788/ajo.2018.0081.
16.	夏燊, 赵泽雨, 吕乾, 等. 跟骨骨折外固定技术的发展. 创伤外科杂志, 2020, 22(2): 148-150.
17.	Yikemu X, Tuxun A, Nuermaimaiti M, et al. Effects of vacuum sealing drainage combined with ilizarov bone transport technique in the treatment of tibial traumatic osteomyelitis. Med Sci Monit, 2019, 25: 6864-6871.
18.	Wang B, Zhang X, Huo Y, et al. Calcaneal lengthening for partial traumatic loss of the calcaneus. Injury, 2019, 50(3): 796-803.
19.	Simpson AH, Deakin M, Latham JM. Chronic osteomyelitis. The effect of the extent of surgical resection on infection-free survival. J Bone Joint Surg (Br), 2001, 83(3): 403-407.
20.	Taylor MN, Chaudhuri R, Davis J, et al. Childhood osteomyelitis presenting as a pathological fracture. Clin Radiol, 2008, 63(3): 348-351.
21.	Heier KA, Infante AF, Walling AK, et al. Open fractures of the calcaneus: soft-tissue injury determines outcome. J Bone Joint Surg (Am), 2003, 85(12): 2276-2282.
22.	DeWall M, Henderson CE, McKinley TO, et al. Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures. J Orthop Trauma, 2010, 24(8): 466-472.
23.	Geel CW, Flemister AS. Standardized treatment of intra-articular calcaneal fractures using an oblique lateral incision and no bone graft. J Trauma, 2001, 50(6): 1083-1089.
24.	Zgonis T, Roukis TS, Polyzois VD. The use of Ilizarov technique and other types of external fixation for the treatment of intra-articular calcaneal fractures. Clin Podiatr Med Surg, 2006, 23(2): 343-353.

1. Gitajn IL, Abousayed M, Toussaint RJ, et al. Anatomic alignment and integrity of the sustentaculum tali in intra-articular calcaneal fractures: Is the sustentaculum tali truly constant? J Bone Joint Surg (Am), 2014, 96(12): 1000-1005.
2. Guerado E, Bertrand ML, Cano JR. Management of calcaneal fractures: what have we learnt over the years? Injury, 2012, 43(10): 1640-1650.
3. Kim Y, Inori F, Yamanaka K, et al. A case of osteomyelitis after calcaneal fracture treature treated by antibiotic-containing calcium phosphate cements. Case Rep Orthop, 2018, (12): 1-4.
4. Oliver NG, Steinberg JS, Powers K, et al. Lower extremity function following partial calcanectomy in high-risk limb salvage patients. J Diabet Res, 2015, (4): 432-164.
5. Rasor ZL, Henning J, Blanton C, et al. Vertical wire forefoot fixation: An advanced technique for the dynamic external fixation apparatus. J Foot Ankle Surg, 2019, 58(5): 1040-1044.
6. Oh EJ, Oh SH, Lee IS, et al. Antibiotic-eluting hydrophilized PMMA bone cement with prolonged bactericidal effect for the treatment of osteomyelitis. J Biomater Appl, 2016, 30(10): 1534-1544.
7. Hamid KS, Parekh SG, Adams SB. Salvage of severe foot and ankle trauma with a 3D printed scaffold. Foot Ankle Int, 2016, 37(4): 433-439.
8. 秦泗河, 焦绍锋, 潘奇. Ilizarov 技术结合游离皮瓣移植治疗创伤后重度马蹄足畸形伴跟骨缺损一例. 中华创伤骨科杂志, 2013, 15(10): 919-920.
9. Masquelet AC. Induced membrane technique: Pearls and pitfalls. J Orthop Trauma, 2017, 31 Suppl 5: S36-S38.36-38.
10. Oh Y, Yoshii T, Okawa A. Ankle arthrodesis using a modified Masquelet induced membrane technique for open ankle fracture with a substantial osteochondral defect: A case report of novel surgical technique. Injury, 2019, 50(11): 2128-2135.
11. Canavese F, Dimeglio A, Bonnel F. Postoperative CT-scan 3D reconstruction of the calcaneus following lateral calcaneal lengthening osteotomy for flatfoot deformity in children. Is the surgical procedure potentially associated with subtalar joint damage?. Foot Ankle Surg, 2018, 24(5): 453-459.
12. 蔡鸿敏, 倘艳锋, 李红军, 等. 保留髂嵴的髂骨翼取骨术. 中华骨科杂志, 2019, 39(10): 589-595.
13. 赵建文, 龙承, 王晓伟, 等. 3D 打印个体化钛笼结合 Masquelet 技术治疗跟骨感染性骨缺损. 中华骨科杂志, 2020, 40(5): 310-316.
14. Cai G, Liu W, Xiong J, et al. Functional reconstruction of hindfoot with total calcaneus and talus loss by ilizarov technique: A case report. J Foot Ankle Surg, 2020, 59(1): 142-148.
15. Hsu AR. Complex ankle and hindfoot arthrodesis using circular external fixation. Am J Orthop (Belle Mead NJ), 2018, 47(9). doi: 10.12788/ajo.2018.0081.
16. 夏燊, 赵泽雨, 吕乾, 等. 跟骨骨折外固定技术的发展. 创伤外科杂志, 2020, 22(2): 148-150.
17. Yikemu X, Tuxun A, Nuermaimaiti M, et al. Effects of vacuum sealing drainage combined with ilizarov bone transport technique in the treatment of tibial traumatic osteomyelitis. Med Sci Monit, 2019, 25: 6864-6871.
18. Wang B, Zhang X, Huo Y, et al. Calcaneal lengthening for partial traumatic loss of the calcaneus. Injury, 2019, 50(3): 796-803.
19. Simpson AH, Deakin M, Latham JM. Chronic osteomyelitis. The effect of the extent of surgical resection on infection-free survival. J Bone Joint Surg (Br), 2001, 83(3): 403-407.
20. Taylor MN, Chaudhuri R, Davis J, et al. Childhood osteomyelitis presenting as a pathological fracture. Clin Radiol, 2008, 63(3): 348-351.
21. Heier KA, Infante AF, Walling AK, et al. Open fractures of the calcaneus: soft-tissue injury determines outcome. J Bone Joint Surg (Am), 2003, 85(12): 2276-2282.
22. DeWall M, Henderson CE, McKinley TO, et al. Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures. J Orthop Trauma, 2010, 24(8): 466-472.
23. Geel CW, Flemister AS. Standardized treatment of intra-articular calcaneal fractures using an oblique lateral incision and no bone graft. J Trauma, 2001, 50(6): 1083-1089.
24. Zgonis T, Roukis TS, Polyzois VD. The use of Ilizarov technique and other types of external fixation for the treatment of intra-articular calcaneal fractures. Clin Podiatr Med Surg, 2006, 23(2): 343-353.

Chinese Journal of Reparative and Reconstructive Surgery

Simultaneous treatment of traumatic calcaneal osteomyelitis and defect deformity with near-arc bone transport by Ilizarov technique

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