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Journal of Bone and Joint Infection An open-access journal of the European Bone and Joint Infection Society and the MusculoSkeletal Infection Society
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Volume 4, issue 3
J. Bone Joint Infect., 4, 146–154, 2019
© Author(s) 2019. This work is distributed under
the Creative Commons Attribution 4.0 License.
J. Bone Joint Infect., 4, 146–154, 2019
© Author(s) 2019. This work is distributed under
the Creative Commons Attribution 4.0 License.

Original full-length article 21 May 2019

Original full-length article | 21 May 2019

Surgical Treatment and Outcomes of Calcaneal Osteomyelitis in Adults: A Systematic Review

Marta Sabater-Martos1,2, Irene Katharina Sigmund1,3, Constantinos Loizou1, and Martin McNally1 Marta Sabater-Martos et al.
  • 1The Bone Infection Unit, Nuffield Orthopaedic Centre. Windmill Rd, Headington. Oxford OX3 7HE, Oxford University Hospitals Foundation NHS Trust, Oxford, UK.
  • 2Department of Orthopaedics and Trauma Surgery. Hospital Universitari Germans Trias i Pujol, Badalona. Carretera del Canyet s/n, 08916 Badalona, Spain.
  • 3Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Spitalgasse 23, 1090 Vienna, Austria.

Keywords: calcaneal osteomyelitis, systematic review, outcome, treatment, muscle flap, antimicrobial carrier, infection.

Abstract. Introduction: Calcaneal osteomyelitis is an uncommon and challenging condition. In this systematic review we aim to analyse the outcomes from concomitant use of bone debridement and soft tissue management for patients diagnosed with calcaneal osteomyelitis.

Materials & Methods: A complete computerised and comprehensive literature search of Pubmed and Cochrane database was undertaken from January 2000 to October 2018. During the review, studies were screened for information about the surgical and antimicrobial treatment, the complications, the reinfection rate and the functional outcome of patients with calcaneal osteomyelitis.

Results: Of the 20 eligible studies included, seven (35%) described bone treatment only, six (30%) soft tissue treatment only, five (25%) soft tissue and bone treatment, and two (10%) focused on prognostic factors and differences in outcomes between diabetic and non-diabetic patients.

In the studies with bone treatment only, infection recurrence ranged from 0 to 35% and the amputation rate from 0 to 29%. If soft tissue coverage was also needed, both the reinfection rate and amputation rate ranged from 0 to 24%. Studies presenting the functional status generally showed preservation or even improvement of the preoperative ambulatory status.

Conclusion: Calcaneal osteomyelitis is difficult to treat. A multidisciplinary approach involving orthopaedic surgeons, plastic surgeons and infectious disease physicians is preferred. The heterogenicity of studies has hindered the development of agreed treatment protocols, which would be useful in clinical practice.

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