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- Title
Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis.
- Authors
Jiang, Nan; Zhao, Xing-qi; Wang, Lei; Lin, Qing-rong; Hu, Yan-jun; Yu, Bin
- Abstract
Background and purpose — The successful eradication of calcaneus infection with limb salvage remains a challenge. We describe the outcomes of cortical bone windowing followed by eggshell-like debridement and implantation of antibiotic-loaded calcium sulphate (CS) for localized (Cierny–Mader type III) calcaneal osteomyelitis (CO). Patients and methods — We report a retrospective study of 34 patients. Infection followed trauma or orthopedic surgery in 30 patients and hematogenous spread in 4 patients. 31 patients had a sinus tract, accompanied by a soft tissue defect in 3 patients. All patients received cortical bone windowing, debridement, multiple sampling, local implantation of vancomycin- and gentamicin-loaded CS, skin closure or flap coverage, and culture-specific systematic antibiotic treatment in a single-stage procedure. Patients were followed up for a median of 26 months. Results — Infection was eradicated in 29 patients after the single-stage surgery, and all of the 5 recurrent infections were cleared by repeated surgery without amputation. Other adverse events included 11 patients with aseptic wound leakage and 1 unrelated death. Compared with those before surgery, the median postoperative scores of the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale (65 vs. 86 vs. 89) and the visual analog scale (VAS) for pain (6 vs. 3 vs. 1) improved at the 1-year and 2-year follow-up. Interpretation — This single-stage protocol, cortical bone windowing, and eggshell-like debridement combined with local implantation of antibiotic-loaded CS is effective in treating type III CO. However, the incidence of aseptic wound leakage is high.
- Subjects
ANTIBIOTICS; COMPACT bone; DEBRIDEMENT; GENTAMICIN; HEEL bone; OSTEOMYELITIS; POSTOPERATIVE care; VANCOMYCIN; CALCIUM compounds; RETROSPECTIVE studies; SURGICAL site; DESCRIPTIVE statistics
- Publication
Acta Orthopaedica, 2020, Vol 91, Issue 3, p353
- ISSN
1745-3674
- Publication type
Article
- DOI
10.1080/17453674.2020.1745423