Victory Over Pediatric Chronic Calcaneal Osteomyelitis With Maintenance of Vancomycin-Permeated Bone Spacer: A Case Avoiding Second-Stage Surgery

Abstract

Chronic calcaneal osteomyelitis in pediatric patients is challenging, with high recurrence rates and limited treatment options. This case report describes an eight-year-old girl with persistent symptoms following a fall. Despite initial antibiotic therapy and debridement, imaging revealed cortical disruption and sequestrum, leading to a diagnosis of chronic osteomyelitis. Surgical debridement and sequestrectomy were followed by vancomycin-impregnated polymethylmethacrylate (PMMA) cement for infection control and mechanical support. A six-week course of oral antibiotics was administered. At three-year follow-up, the patient remained symptom-free without the need for second-stage surgery to remove the PMMA cement. This case illustrates the success of single-stage, antibiotic-loaded PMMA cement in treating pediatric chronic calcaneal osteomyelitis, yielding long-lasting functional and infection-free outcomes. The use of PMMA cement offers key advantages, such as excellent biocompatibility, ease of handling, straightforward processability, and cost-effectiveness.

Keywords: calcaneal osteomyelitis; chronic recurrent osteomyelitis; osteomyelitis diagnosis; osteomyelitis of the calcaneus; paediatric calcaneum osteomyelitis; pediatric chronic osteomyelitis; pediatric osteomyelitis; polymethylmethacrylate (pmma); vancomycin powder; vancomycin-impregnated pmma cement.

Figure 1. Preoperative radiograph of patient's right foot in oblique view (A) and CT image in sagittal plane (B)

The lytic lesions and sequestrum, highlighted in red, show the bone destruction caused by osteomyelitis.

Figure 2. Postoperative radiographs with antibiotic bone cement filling the cavity showing in lateral (A) and anteroposterior (B) view

Figure 3. Postoperative radiographs in the lateral (A) and anteroposterior (B) views, showing the antibiotic bone cement spacer in place after 3 years