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Staged Ilizarov distraction histogenesis and corrective reconstruction for severe malunited calcaneal fractures

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Severe calcaneal malunion is a clinical conundrum for the difficulty of calcaneal reconstruction without soft tissue complications. The aim of this study is to introduce the treatment strategy and preliminary results of staged Illizarov distraction histogenesis and corrective reconstruction for severe malunion of calcaneal fractures.

Methods

From June 2014 to May 2020, 14 patients with severe calcaneal malunion treated with the staged strategy were retrospectively analyzed. At the first stage, calcaneal osteotomy and external fixation with Ilizarov frame were performed. The restoration of the approximate configuration of calcaneus and the expansion of contractural soft tissue were achieved by gradual calcaneal distraction. At the second stage, corrective reconstruction was performed and autogenous iliac crest bone graft was used. Clinical and radiographic outcomes were evaluated at final follow-up.

Results

The average time of Ilizarov distraction and total fixation was 21.4 days and 41.0 days at first-stage treatment. At a mean follow-up of 33.1 months, the average American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score increased significantly from 24.0 to 72.4 (p < 0.01). And the mean visual analogue scale (VAS) score had improved remarkably from 8.2 to 2.4 (p < 0.01). Radiographs showed that talocalcaneal height, calcaneal width, calcaneal tuberosity height, hindfoot alignment angle, and talar declination angle were improved to a great extent (p < 0.01). Only one patient had minor pin site infection at first-stage treatment and one got superficial wound infection after second-stage surgery. No wound dehiscence, skin necrosis, or deep infection occurred.

Conclusion

Staged Ilizarov distraction histogenesis and corrective reconstruction is a safe and effective treatment strategy for reducing soft tissue complications and improving reconstruction results in surgical correction of severe calcaneal malunion.

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Data availability

The data of the current study is available from the corresponding author on reasonable request.

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Acknowledgements

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Avenue, Chengdu, 610041, Sichuan, China

    Ting-Jiang Gan, Ya-Xing Li, Xi Liu, Yu Chen, Jia Li & Hui Zhang

  2. Disaster Medicine Center, Sichuan University, Chengdu, 610041, Sichuan, China

    Ya-Xing Li & Hui Zhang

Authors
  1. Ting-Jiang Gan
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  2. Ya-Xing Li
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  3. Xi Liu
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  4. Yu Chen
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  5. Jia Li
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  6. Hui Zhang
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Contributions

ZH and CY performed the operations. Data collection and material preparation were performed by all authors. First draft of the manuscript was written by GTJ, then ZH, LYX, LX and LJ commented for adequate changes of its final version. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hui Zhang.

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All authors declare that they have no competing interests.

Ethical approval

This study was performed in accordance with the Helsinki declaration of 1964, and it was approved by the relevant Institutional Review Board at the West China Hospital of Sichuan University.

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Informed consent was obtained from all patients.

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Informed consent was obtained from all patients.

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Cite this article

Gan, TJ., Li, YX., Liu, X. et al. Staged Ilizarov distraction histogenesis and corrective reconstruction for severe malunited calcaneal fractures. Arch Orthop Trauma Surg 143, 2845–2854 (2023). https://doi.org/10.1007/s00402-022-04449-7

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  • DOI: https://doi.org/10.1007/s00402-022-04449-7

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