Treatment of calcaneal tumors by calcanectomy and reconstruction with vascularized iliac crest structural graft

Goals: Different techniques have been described for treatment of tumors of the calcaneus, when a complete excision of the calcaneus is necessary. Due to the rarity of this condition, reports in Literature mostly concerned single case reports. The Authors describe their experience in reconstruction of the calcaneus with a vascularized structural iliac graft in three patients. Methods: The vascularized graft was shaped to adequately fit the gap left by calcaneal excision and to present an adequate inferior side for weight-bearing heel function, rotating the graft to place the superior iliac crest on the plantar side. A groove was created on the lower surface of the talus for graft setting; fixation was achieved by screws from the crest to the talus and the cuboid in two cases and with a plate from the crest to the cuboid and screws to the talus in one case. Patients were affected by osteoblastoma (1 case), benign fibrous istiocitoma (1 case) and giant cell tumor (1 case). Age at surgery ranged from 18 to 29 (average 24). Results: In all cases fusion of the graft occurred without complications and no secondary surgical procedure was needed. Complete weight-bearing was allowed at about 6 months from surgery. All patients were continuously disease free at an average follow-up of 60.3 months (ranging from 20 to 89). At follow-up MSTS/ISOLS functional score was respectively 93,3%, 93,3% and 53,3.% in the three patients. In two patients there was no pain and an unlimited walking ability; the third patient (the one with the shortest follow-up) presented a complete radiographic fusion of the graft but he complained of persistent heel pain on weight-bearing. A gait analysis and baropodometric evaluation was performed at follow-up.and results are presented and discussed. Conclusion: Reconstruction of a functional heel after calcaneal excision is a challenging procedure. In Authors’ experience, the use of a vascularized structural iliac crest graft showed to be a mechanical effective procedure, durable in time and with satisfactory functional results.