ORIGINAL RESEARCH article
Front. Surg.
Sec. Orthopedic Surgery
This article is part of the Research TopicNew Perspectives in Bone and Joint Infections Diagnosis and TreatmentView all 4 articles
Midshaft Tibial Osteotomy and Bone Transport for Tibiocalcaneal Joint Reconstruction
Provisionally accepted
- 1The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- 2Department of Forensic Medicine, School of Basic Medicine, Key Laboratory of Forensic Medicine, Xinjiang Medical University, Urumqi, China
- 3920th Hospital of People's Liberation Army Joint Logistic Support Force, Kunming, China
- 4Hangzhou Tianmushan Hospital, Hangzhou, China
- 5Air Force Medical University Tangdu Hospital, Xi'an, China
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Abstract Background: 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 versus 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. Methods: 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. Results: 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. Conclusion: 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.
Keywords: Ankle arthrodesis, Hindfoot deformities, Ilizarov distraction osteogenesis, minimally invasive osteotomy, TC arthrodesis
Received: 01 Dec 2025; Accepted: 31 Jan 2026.
Copyright: © 2026 Pan, Wang, Zhao, Gong, Zhu and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhen Shi
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