Treatment of Calcaneal Fracture With Severe Soft Tissue Injury and Osteomyelitis: A Case Report

Clinical characteristics, treatment and efficacy of calcaneal osteomyelitis: a systematic review with synthesis analysis of 1118 reported cases

BACKGROUND

Calcaneal osteomyelitis (CO) still poses great challenges to orthopedic surgeons due to the unique anatomic and functional features of the calcaneus. This study summarized the current data regarding clinical characteristics, treatment and efficacy of CO, based on an analysis of literature-reported cases.

MATERIALS AND METHODS

The authors searched the PubMed, Embase, and Cochrane Library databases to find English and Chinese studies reporting on CO patients published between 2000 and 2021, with available data for synthesis analysis. The quality of the included studies was evaluated by the National Institutes of Health (NIH) assessment scale. Effective data were extracted and pooled for analysis.

RESULTS

Altogether 198 studies involving 1118 patients were included, with a male-to-female ratio of 2.3 (724 males and 310 females). The median age at CO diagnosis was 46 years, with a median symptom duration of 3 months. Injury-related infections (524 cases) and diabetic foot infections (336 cases) were the two most common causes, with ulcers (468 cases) and wound sinus or exudation (209 cases) being the predominant symptoms. The overall positive culture rate was 80.2%, with polymicrobial infections accounting for 18.1%. Staphylococcus aureus was the most frequently detected pathogen (42.7%), with fungal-related infections isolated in 17 cases. Although most patients received surgical interventions (96.9%), the recurrence rate was 20.1%. The incidence of infection relapse following partial calcanectomy, total calcanectomy, debridement with implantation of local antibiotics, and debridement with or without flap or skin coverage were 31.7%, 45.0%, 16.8%, and 15.1%, respectively. The overall incidence of limb amputation was 12.4%, with all-cause and CO-related mortalities of 2.8% and 0.2%, separately.

CONCLUSIONS

CO shared similar characteristics with extremity chronic osteomyelitis, primarily affecting young males, with trauma and diabetic foot as the leading causes and Staphylococcus aureus as the most frequently detected pathogen. Despite surgery being the primary treatment modality, clinical outcomes remained unsatisfactory, marked by high rates of infection recurrence and limb amputation.

The use of free fibula-flexor hallucis longus osteomuscular flap for calcaneal reconstruction after partial calcanectomy for the chronic osteomyelitis: A case report

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Calcaneal osteomyelitis is difficult to eradicate.

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Calcaneal debridement and infection control are critical.

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Osteomuscular flaps offer a stable and effective reconstruction.

Introduction

Calcaneal osteomyelitis poses a tough challenge for any reconstructive surgeon. The eradication of the infection and the reconstruction of the defect are the main goals of treatment.

Presentation of case

We present the case of a 53-year-old male with chronic calcaneal osteomyelitis. The patient was submitted to several bone and soft tissue debridements and twice the application of gentamicin/sulfate implants at the wound bed with no success. He was then submitted to a partial calcanectomy followed by obliteration of the bone defect (4.5 × 2 × 1.5 cm) with a free vascularized fibula-flexor hallucis longus osteomuscular flap (bone dimension:4.5 × 1.5 × 1.2 cm; muscle size: 4 × 1.5 × 0.5 cm). The flap remained viable, and the post-operative period was uneventful. Bone incorporation was evident nine months after the surgery with no signs of recurrent infection or avascular necrosis. Final follow up, at one year, showed an excellent functional result. The patient was able to ambulate without assistance and referred occasional minimal foot pain. Donor site morbidity was minimal.

Conclusion

The authors believe that this osteomuscular flap may be a valuable option to reconstruct calcaneal defects after chronic osteomyelitis.