Eggshell debridement combined with vascularized fibular grafting for the treatment of bilateral calcaneal osteomyelitis and bone defects: a case report

Bone defect following debridement for calcaneal osteomyelitis presents both a clinical challenge to surgeons and a significant burden to patients. A 68-year-old male patient sustained multiple injuries, including bilateral calcaneal fractures, due to a fall from height. He underwent open reduction and internal fixation (ORIF) for bilateral calcaneal fractures and left fibular fracture at an external institution. Two months postoperatively, sinus tracts developed at the bilateral incision sites, leading to a diagnosis of bilateral calcaneal infection. The patient subsequently received multiple debridement procedures and antibiotic-loaded bone cement implantation. In our management, we performed one-stage eggshell debridement and vascularized fibular grafting immediately after removing the antibiotic-loaded bone cement. At the final follow-up, radiological evaluations revealed satisfactory graft integration and stable positioning. The postoperative Maryland Foot Score was 85 for the left foot and 90 for the right foot, indicating favorable functional recovery, with the patient reporting high satisfaction. This case suggests that one-stage eggshell debridement combined with vascularized fibular grafting, performed after the removal of antibiotic-loaded bone cement following initial debridement for calcaneal infection, can provide reliable stability and achieve favorable clinical outcomes.