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

## TL;DR

A child with chronic heel bone infection was successfully treated with a single surgery using antibiotic-loaded cement, avoiding further operations.

## Contribution

This case demonstrates the successful use of vancomycin-impregnated PMMA cement in treating pediatric chronic calcaneal osteomyelitis without second-stage surgery.

## Key findings

- A single-stage treatment with vancomycin-loaded PMMA cement led to long-term infection control in a pediatric patient.
- The patient remained symptom-free for three years without requiring removal of the PMMA cement.
- PMMA cement provided mechanical support and sustained antibiotic release, avoiding the need for additional surgeries.

## 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.