Abstract
Introduction. Radical procedures like calcanectomy and amputation performed for calcaneal osteomyelitis are regarded as effective in eradication of infection even though potentially functionally disabling. Bone sparing procedures offer better functional result at the expense of potentially worse infection control. The aim of the study has been to assess the influence of the surgical radicalism as much as the extent of bone infection on the final outcome in the surgical therapy of chronic calcaneal osteomyelitis (CO). Material and method. 32 patients with chronic CO have comprised the group under study: 8 with superficial type, 12 localised type and 12 with diffuse type according to Cierny-Mader classification. The aim of the treatment was to heal infection, preserve the heel shape and achieve good skin coverage over the calcaneus. The therapy consisted of 9 debridement surgeries with or without flaps, 8 drilling-operations of the calcaneus with application of collagen-gentamicin-sponge in bore holes, 15 partial and 2 total calcanectomies, and 4 below-the knee amputations. Results. The healing of infection and wound has been achieved after 7 of 9 debridements, 6 of 8 drilling-operations, 13 of 15 partial and all total calcanectomies. Conclusion. Bone preserving operations in chronic calcaneal osteomyelitis provided inferior infection control (76,47% vs 88,24%) and worse patient satisfaction (88,24% vs 100%) and almost camparable ambulation (100% vs 93,33%). Drilling of the calcaneus with application of collagen sponge containing gentamicin performed in chronic diffuse calcaneal osteomyelitis seems to offer a viable alternative to partial or radical calcanectomy. Level of evidence: V.
Highlights
Radical procedures like calcanectomy and amputation performed for calcaneal osteomyelitis are regarded as effective in eradication of infection even though potentially functionally disabling
In 4 cases with diffuse calcaneal osteomyelitis (CO) partial calcanectomy has been http://www.jbji.net ineffective and a total calcanectomy has been performed in 2 cases and in 2 other cases a below-the knee amputation
The biodegradable carriers like collagen-gentamicin sponge (CGS), hydroxyapatite blocks, polylactide/polyglycolide implants and the polylactate polymers release antibiotics at local concentrations exceeding those of the minimum inhibitory concentrations (MICs) for the most common pathogens of chronic osteomyelitis, without producing http://www.jbji.net toxic systemic concentrations and adverse effects [14]
Summary
Radical procedures like calcanectomy and amputation performed for calcaneal osteomyelitis are regarded as effective in eradication of infection even though potentially functionally disabling. Bone preserving operations in chronic calcaneal osteomyelitis provided inferior infection control (76,47% vs 88,24%) and worse patient satisfaction (88,24% vs 100%) and almost camparable ambulation (100% vs 93,33%). Drilling of the calcaneus with application of collagen sponge containing gentamicin performed in chronic diffuse calcaneal osteomyelitis seems to offer a viable alternative to partial or radical calcanectomy. Chronic calcaneal osteomyelitis (CO) is a rare form of bacterial osteomyelitis [1] It develops either as sequelae of penetrating wound located over the calcaneus, especially in diabetic patients with vascular compromise, or as hematogenous bone infection [2, 3, 4]. Changes with the extension within the calcaneus greater than 50% are classified as diffuse CO
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