(DLS-012) Staged Multifaceted Limb Salvage Approach to Pathologic Calcaneal Fracture Secondary to Neglected Osteomyelitis Associated with Non-healing Wound
Friday, April 28, 2023
7:15 PM - 8:30 PM East Coast USA Time
John Pelosi, DPM; Janie Staravecka, DPM; John Watson, DPM
Introduction: Osteomyelitis is a bone infection commonly associated with diabetic foot ulcerations, with about 50% leading to severe infections. A pathologic fracture is one of several complications that can result from neglected chronic ulcerations. This case presents a calcaneal pathologic fracture secondary to neglected osteomyelitis associated with a non-healing ulceration. The patient was referred to the wound care center for a second opinion following a recommendation of a below-knee-amputation (BKA) by his initial treating physician. A multi-faceted approach was utilized to obtain limb salvage.
Methods: This case follows a 33-year-old male with past medical history diabetes, hyperlipidemia, hypertension, schizophrenia, who presented with a full thickness ulceration following a plantar heel puncture wound injury to a separate facility. Records were obtained showing the patient had multiple debridements and graft applications attempted throughout a 7 month period, with persistent failure, as his osteomyelitis was never addressed. At this time, the patient presented to our wound care facility, with calcaneal fracture noted on imaging. Biopsies were obtained, and he was treated with IV antibiotics, staged debridements, and antibiotic cement application, with reduction of the calcaneal fracture and external fixation. Wound closure was obtained using cryo-proserved allograft application, and the final procedure consisted of removal of external fixation with antibiotic calcaneal rod placement.
Results: The underlying osteomyelitis of the calcaneus was diagnosed and addressed which allowed us to heal the wound site and for consolidation of the pathologic fracture.
Discussion: Osteomyelitis must be addressed prior to application of grafts and associated wound care, otherwise time to healing can be significantly delayed and can pose a huge risk to patient safety, leading to potential loss of limb.
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