Surgical treatment of fracture-related infections of the calcaneus with relevant soft-tissue defects.

Abstract

Fracture-related infection (FRI) of the calcaneus with associated soft tissue defects after open reduction and internal fixation (ORIF) presents significant therapeutic challenges. This study evaluates the efficacy of two filling techniques-bone cement with local flap transfer (BC+LFT) and free myocutaneous flap (FMF)-in managing these complex cases, with consideration of the FRI classification system. A retrospective analysis on patients treated between June 2017 and June 2024 was done. Based on post-debridement defect size, patients were allocated to BC + LFT (defects ≤3 cm) or FMF (defects >3 cm). All cases were classified according to the FRI criteria. Surgical management included radical debridement, dead space obliteration, and soft tissue reconstruction. Outcomes were assessed via AOFAS hindfoot scores, VAS pain scores, complication rates, and radiographic evaluation. A total of 43 patients were included (25 BC+LFT, 18 FMF). The FMF group had longer operative times and greater blood loss (p < 0.05), but no significant differences were observed in debridement frequency, hospitalization, or complication rates. Both groups showed significant improvement in functional and pain scores at final follow-up. Fracture union was achieved in all cases without recurrence of infection. Both BC + LFT and FMF are effective for managing calcaneal FRI with soft tissue defects. The choice of technique should be individualized based on defect size and patient factors, with FRI classification providing valuable guidance for clinical decision-making.