The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

Abstract

Background: To analyze the epidemiology and features of calcaneus osteomyelitis following open reduction and internal fixation (ORIF) after closed calcaneus fracture.Methods: We retrospectively analyzed 127 cases who were diagnosed with calcaneal osteomyelitis following ORIF via the extended lateral "L-shaped" approach after closed calcaneus fracture between March 2016 and August 2019 in our hospital. We analyzed participant demographics including gender, age, body mass index (BMI), trauma mechanism, Sanders classification, co-morbidity, time between initial injury and surgery, operating time, soft tissue stripping tools, tourniquet pressure, bone grafting option, internal fixation option, presence of bleeding after tourniquet deflation, and drainage option.Results: The majority of cases (n=127) were male (4.5 times more than female gender), at a ratio of 4.47:1.Falling from height was the main trauma mechanism (79.53%), followed by traffic accident (14.17%), and jumping (6.3%). A total of 51 cases (40.16%) were left-side fractures, and 76 (59.84%) were right-sided.According to the Sanders classification, 12 cases were type II (9.45%), 61 cases were type III (48.03%), and 54 cases were type IV (42.52%). There were 25 participants with the co-morbidity of type 2 diabetes mellitus (19.69%), 7 with hypertension (5.51%), and 1 case each of psoriasis and sicca syndrome (0.8%). The mean time to surgery was 4.7 days (4-9 days), and 123 participants (96.85%) were treated within 7 days. The mean operating time was 102.1 min (75-135 min). Forty-four participants (34.65%) received the conventional scalpel and 83 participants (65.35%) the electric scalpel during soft tissue stripping intraoperatively. The mean tourniquet pressure was 432.3 mmHg (350-550 mmHg). Autologous bone grafting was observed in 6 cases (4.72%), allograft bone grafting in 11 cases (8.67%), and OsteoSet grafting in 7 cases (5.51%).A locking plate was used in 114 cases (89.76) while anatomical plate in 13 cases (10.24%). A total of 27 participants (21.26%) bled after tourniquet deflation. Drainage tubes were applied in 30 participants (23.62%) while rubber drainage strips in 5 participants (3.94%).Conclusions: Young males dominated the calcaneus osteomyelitis following traumatic calcaneus fracture cohort in this study. A fall from height was the most frequent trauma mechanism. The presence of severe calcaneus fracture, Sanders type III (48.03%) and type IV (42.52%), were the common fracture types in this population group.

Similarities and Differences Between Diabetes-Related and Trauma-Related Calcaneal Osteomyelitis: Comparisons Based on 681 Reported Cases

“… 6 In that cohort, the ratios of the females patients with diabetic-foot OM (DFOM) and post-traumatic OM (PTOM) were 39.1% and 17.2%, with the median ages at diagnosis being 62 years (DFOM) and 38 years (PTOM), respectively. Among the included studies analyzing TRCO, the investigation with the largest sample size (127 patients) was reported by Huang et al, 15 who summarized clinical features of TRCO. They concluded that young (mean age: 46.8 years) and males (male/female = 4.47) were dominated, which was in line with our results (TRCO: median age: 44 years, male/female = 3.12).…”

Long-Term Follow-up of Complex Calcaneal Osteomyelitis Treated With Modified Gaenslen Approach

“…The weight bearing surface of the heel is prone to fracture-related infections, penetrating injury, and pressure ulceration, particularly in the context of peripheral neuropathy. 15 , 16 The fundamental steps in treating chronic osteomyelitis include physiological optimization of the patient, a thorough debridement of poorly vascularized and infected bone, dead space management, ensuring skeletal stability, appropriate antibiotics based on careful intraoperative sampling, and adequate soft tissue coverage. 11 Accomplishing these objectives can be difficult when there is extensive osteomyelitis of the calcaneus.…”

The Concept of Treatment for Surgical Infection in the Hindfoot

“…In cases of open calcaneal fractures, the complication rate increases by 5 to 7 times. 15 , 16 , 33 Many authors have noted that in open calcaneal fractures, infection can affect up to 60% of cases, sometimes necessitating amputations, with postoperative infections affecting up to 25% of patients. 6 , 14 , 42 As Morgenstern et al 32 have noted, there are currently no specific diagnostic criteria for fracture-related infections.…”