[Pyogenic osteomyelitis after a plantar puncture wound: analysis of a series of 8 cases].

BACKGROUND

The aim of this study was to know the incidence of osteoarticular infection secondary to plantar puncture, in the authors' center, and review the clinical characteristics, diagnosis and treatment.

PATIENTS AND

METHODS

A retrospective analysis of the cases of osteomyelitis and/or pyogenic arthritis secondary to plantar puncture admitted from 1986 to 1994 in the authors' hospital.

RESULTS

Eight cases of osteoarticular infection secondary to plantar puncture (all males with a mean age of 37.2 years) were analyzed with a prevalence of 1.65% out of the total number of plantar punctures attended in the emergency department. The mechanism of the wound was, in all the cases, that of stepping on a nail. The most frequent clinical manifestations were pain and signs of local inflammation. Systemic repercussion was not observed in any case. A monomicrobial culture was obtained in 6 cases (in five P. aeruginosa was isolated). Combined surgical and antibiotic treatment was performed in 7 patients. A foreign body was found in only one case. The mean length of antibiotic treatment was five weeks.

CONCLUSIONS

Initial surgical treatment of plantar punctures is fundamental, in addition to home instructions and follow up to avoid late severe infectious complications. The role of radiology and other diagnostic imaging techniques should be considered to detect foreign bodies. The role of prophylatic antibiotics is controversial but may be indicated in certain cases.