Long term functional outcomes of a permanent antibiotic cement spacer for chronic distal tibial osteomyelitis in a patient with diabetes

A 66-year-old male with chronic right distal tibial osteomyelitis presents with erythema and a draining sinus tract concerning for acute exacerbation. Previously stable on amoxicillin/clavulanate, worsening symptoms for 3–4 months prompted referral. Following evaluation, treatment consisted of debridement, insertion of an antibiotic cement spacer into the partial cortical tibial defect and free flap coverage. At five-year follow up, the antibiotic spacer remains in place without recurrence of osteomyelitis and with preserved function. Further investigation is needed to validate permanent retention of an antibiotic spacer as an alternative to vascularized or non-vascularized bone grafts for management of chronic tibial osteomyelitis in the comorbid diabetic limb salvage population.