Calcanectomy: Avoiding major amputation in the presence of calcaneal osteomyelitis—A case series

Walsh, Tom P.; Yates, Ben

doi:10.1016/j.foot.2013.09.002

Cited by 24 publications

(22 citation statements)

References 24 publications

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“…To the best of our knowledge, no studies have yet determined the causative pathogens of POWI after operative treatment of calcaneal fractures, although some studies have specified the pathogens for calcaneal osteomyelitis. Overall, these studies reported S. aureus as the main pathogen (19)(20)(21). In a study of infection after all types of orthopedic open fractures, the most frequently identified microorganisms were Enterobacter species and Pseudomonas (31%), followed by Enterococcus species in 27% of cases (22).…”

Section: Discussionmentioning

confidence: 99%

Determination of Pathogens in Postoperative Wound Infection After Surgically Reduced Calcaneal Fractures and Implications for Prophylaxis and Treatment

Backes

Spijkerman

Muinck-Keizer

et al. 2018

The Journal of Foot and Ankle Surgery

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High rates of postoperative wound infection (POWI) have been reported after surgery for calcaneal fractures. This is a retrospective cohort study to determine the causative pathogens of these infections and subsequent treatment strategies. In addition, microbacterial growth from superficial wound swabs and deep fluid or tissue cultures were compared. Patients with a unilateral surgically treated calcaneal fracture during a 15-year period were included. Patient, fracture, and surgical characteristics were collected from the electronic medical records. An infection was categorized as deep or superficial using the Centers for Disease Control and Prevention criteria. Secondary outcomes were wound edge necrosis and wound dehiscence. The collection of culture swabs, their results, and treatment strategies were documented. Of 357 patients, 92 (26%) developed a POWI; 55 (60%) deep and 37 (40%) superficial. The most frequent causative pathogens were Enterobacteriaceae and Staphylococcus aureus. Of the 55 patients with deep infection, 31 (56%) were treated with intravenous antibiotics and surgical debridement, 2 (4%) with intravenous antibiotics, and 22 (40%) with implant removal. In 33 of 92 patients (36%) with a POWI, both superficial and deep cultures were obtained, with a microorganism not cultured from the superficial swab 13 (39%) times. In conclusion, we found that one quarter of patients with operative calcaneal fracture treatment developed a POWI, mainly caused by Enterobacteriaceae or S. aureus. Physicians should not rely on the results of superficially obtained cultures for adequate treatment of deep infection. Because the spectrum of sensitivity profiles varies greatly between hospitals and countries, we recommend empiric antibiotic treatment of both gram-positive and gram-negative microorganisms on suspicion of deep infection.

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Section: Discussionmentioning

confidence: 99%

Determination of Pathogens in Postoperative Wound Infection After Surgically Reduced Calcaneal Fractures and Implications for Prophylaxis and Treatment

Backes

Spijkerman

Muinck-Keizer

et al. 2018

The Journal of Foot and Ankle Surgery

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“…Of these, 10 were managed with wound dressing and 1 underwent a secondary debridement surgery to remove the residual CS; all of these patients recovered well. In addition, 1 patient died of a cause unrelated to amputation following limb-saving surgery in CO patients ranged from 4% to 20% (Baumhauer et al 1998, Schade 2012, Van Riet et al 2012, Walsh and Yates 2013, Babiak et al 2016. Even a recent study (Waibel et al 2019) showed that 50% of the CO patients had to undergo secondary below-knee amputation even if they had already received total calcanectomy.…”

Section: Infection Eradication Rate and Adverse Eventsmentioning

confidence: 99%

“…Compared with polymethylmethacrylate (PMMA), CS can carry a wider range of antibiotics and is completely biodegradable, thus not requiring second surgery for removal (Inzana et al 2016). Although previous studies had reported local antibiotic-loaded CS implantation for CO treatment, their strategies differed, including a 2-stage surgery of debridement followed by autologous bone graft (Papagelopoulos et al 2006), the Silo technique with CS/hydroxyapatite (Drampalos et al 2018), and even calcanectomy (Walsh and Yates 2013). Nonetheless, the clinical experience of bone-preserving strategy for CO treatment remains limited.…”

mentioning

confidence: 99%

Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis

et al. 2020

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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.

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“…Surgical treatment options for calcaneal osteomyelitis in the context of heel PU include partial calcanectomy , total calcanectomy and (occasionally) total excision of the calcaneus and the talus . In general, these procedures are seen as limb saving and performed in individuals otherwise requiring trans‐tibial or trans‐femoral amputation.…”

Section: Treatmentmentioning

confidence: 99%

“…The most common microorganisms are Staphylococcus and Pseudomonas . The diagnosis is often made by a combination of plain radiographs and blood tests, which may be supplemented by more sensitive tests such as radionuclide bone scans and cross‐sectional imaging . However, if a wound probes to bone in a diabetic patient, the likelihood of osteomyelitis is very high .…”

Section: Treatmentmentioning

confidence: 99%

A review of the surgical management of heel pressure ulcers in the 21st century

Bosanquet

Wright

White

et al. 2015

International Wound Journal

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Heel ulceration, most frequently the result of prolonged pressure because of patient immobility, can range from the trivial to the life threatening. Whilst the vast majority of heel pressure ulcers (PUs) are superficial and involve the skin (stages I and II) or underlying fat (stage III), between 10% and 20% will involve deeper tissues, either muscle, tendon or bone (stage IV). These stage IV heel PUs represent a major health and economic burden and can be difficult to treat. The worst outcomes are seen in those with large ulcers, compromised peripheral arterial supply, osteomyelitis and associated comorbidities. Whilst the mainstay of management of stage I-III heel pressure ulceration centres on offloading and appropriate wound care, successful healing in stage IV PUs is often only possible with surgical intervention. Such intervention includes simple debridement, partial or total calcanectomy, arterial revascularisation in the context of coexisting peripheral vascular disease or using free tissue flaps. Amputation may be required for failed surgical intervention, or as a definitive first-line procedure in certain high-risk or poor prognosis patient groups. This review provides an overview of heel PUs, alongside a comprehensive literature review detailing the surgical interventions available when managing such patients.

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Calcanectomy: Avoiding major amputation in the presence of calcaneal osteomyelitis—A case series

Cited by 24 publications

References 24 publications

Determination of Pathogens in Postoperative Wound Infection After Surgically Reduced Calcaneal Fractures and Implications for Prophylaxis and Treatment

Determination of Pathogens in Postoperative Wound Infection After Surgically Reduced Calcaneal Fractures and Implications for Prophylaxis and Treatment

Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis

A review of the surgical management of heel pressure ulcers in the 21st century

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