PMC6020476_01
Lateral radiograph of the left foot following injury. X-ray shows the tongue-type fracture of the left calcaneus.
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The next day, she was admitted to our hospital and was diagnosed with closed tongue-type calcaneal fracture (Figure 1).
Lateral radiograph of the left foot following the first surgery. X-ray shows that the left calcaneus was almost completely reduced with two Steinmann pins.
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Operation was performed using 2 pins of the Steinmann pin by the Westhues method (Figure 2).
Left heel as seen from the posterior aspect after 9 days from the pin removal. Skin redness, swelling, and pus-like discharge were observed around the surgical site.
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On the examination, skin redness, swelling, and pus-like discharge were observed around the surgical site (Figure 3).
Fat suppressed T2-weighted left ankle magnetic resonance sagittal images before the 2nd operation. High-intensity area was confirmed around the pin tract (black triangle) and body of calcaneus (white arrow). Abscess formation was suspected.
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Plain X-ray showed hyperpermeability of the calcaneus, and magnetic resonance images confirmed a diagnosis of osteomyelitis of the calcaneus as well as an abscess formation (Figure 4).
Intraoperative fluoroscopy of the left calcaneus at the 2nd operation. (a) Vancomycin-containing CPC was poured from the lateral side. (b) Defect of the calcaneal body and pin tracts were filled with CPC. We carefully confirmed that there were no leaks of CPC in the subtalus joint intraoperatively.
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Medical, Tokyo, Japan) with vancomycin was implanted at the defected site of the calcaneus (Figure 5). MSSA was also cultured positive from the bone marrow of the calcaneus.
Left heel as seen from the posterior aspect after 6 months from the 2nd operation. The pin tract's fistula was completely closed, and there was no recurrence of infection.
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On the 6th postoperative month, fistula was completely closed and there was no recurrence of infection (Figure 6).