Calcaneal hybrid reconstruction with femur head allograft enriched with bone marrow and ALT flap

Abstract

Open calcaneal fractures with bone and soft tissue loss often require complex reconstructive strategies aimed at restoring the hind-foot anatomy and physiologic ambulation. Although there is no established gold standard for treatment, the techniques utilized include bone autografts and allografts, composite flaps, and prosthesis. We report the case of a 43-year-old healthy man, who suffered an open fracture of the right calcaneus with bone loss and a wide soft tissue defect, following a motorcycle accident. After the emergency management, a reconstruction with a femur head allograft and free anterolateral thigh flap (ALT) was planned. The allograft was shaped with the aid of 3D-printed models of the defect and residual calcaneal bone. Concentrated bone marrow aspirate (cBMA) was utilized as a biological adjunct to promote osteointegration by enhancing new bone formation. The soft tissue defect was reconstructed with an anterolateral thigh flap (ALT), harvested from the contralateral thigh, and anastomosed with the posterior tibial vessels. Off-label treatment with Teriparatide was initiated postoperatively, to further boost the healing process. The reconstruction was successful, with full weight bearing reached at 6 post-operative months, and no reported complications over the 8 months follow-up.