| 要約: | This case study presents a treatment algorithm including revision surgery for recurrent displacement of tongue type calcaneal fractures complicated by osteomyelitis and local soft tissue deficit. Most literature focuses on pathologic fractures through infected bone, with prior research citing suture anchors, one versus two stage curettage with use of antibiotic containing calcium phosphate cement. A 36 year old male sustained a displaced tongue type calcaneal fracture who initially underwent cannulated screw fixation. He was lost to early follow up due to social issues and was seen 30 days later with hardware failure, a large posterior soft tissue deficit, soft tissue and bone infection, and fracture recurrence. Patient underwent multiple staged surgeries involving incision and drainage, removal of failed hardware, bone biopsy, antibiotic bead placement, and long term IV antibiotics. Final reconstruction 9 days later included fracture reduction aided by Achilles z-lengthening, internal fixation, and a medial forearm fasciocutaneous free flap to address the posterior soft tissue deficit. Limb loss was a possible outcome without a multidisciplinary approach including a free flap from our plastic surgery partners. The treatment protocol outlined in this report emphasizes the importance of early removal of failed hardware, repeat irrigation and curettage, antibiotic impregnated beads for local antibiotic delivery, targeted IV antibiotic therapy, serial bone biopsy, and interdisciplinary consultation for management of a large skin defect compromised by infection.
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