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Pin-site myiasis: a rare complication of a treated open fracture of tibia
Luis A Paris1, Mikel Viscarret, Cesar Uban
1Traumatology Service, Hospital Dr. Rafael Medina Jiménez, Pariata, Vargas, Caracas, Venezuela.
Background:
Pin-site myiasis is a rare complication of external fixation of open fractures of the tibia.
Methods:
Case report and literature review.
Results:
A 32 year-old man with a history of alcohol and drug abuse presented with an open fracture of the middle third of the fibula and tibia (Gustilo type IIIA) after a motor vehicle crash. Definitive surgical correction of the fracture was made with the insertion of an external skeletal fixator, type Baummer, with 2 bars, 6 pins, and 12 rotules. After three weeks, he presented again with a primary complaint of purulent secretion and maggots at the distal pin site. On removal of the pin, significant destruction of peripheral tissue was evidenced, with a wound approximately 5 cm diameter, from which 105 maggots were extracted, being identified as Cochliomyia hominivorax.
Conclusions:
There have been no previous reports of myiasis involving an external skeletal fixation and pin, and only one similar case has been reported in a patient with a halo orthosis for the management of a gunshot wound of the neck. As in that case, presumably, in our patient, myiasis occurred via the small infected wound adjacent to the distal pin. Adequate treatment for myiasis requires complete removal of the maggots, as well as antimicrobial therapy.
Insights
Pin-site myiasis, a rare complication of external fixation, occurred in a tibia fracture patient. This case highlights the need for prompt maggot removal and antimicrobial therapy for effective treatment.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Parasitology
Background:
- Pin-site myiasis is a rare complication associated with external fixation devices used for open fractures.
- External fixation is a common orthopedic technique for managing complex fractures, particularly of the tibia.
Observation:
- A 32-year-old male with a Gustilo type IIIA open fracture of the tibia and fibula developed pin-site myiasis.
- Maggots (Cochliomyia hominivorax) were discovered at the distal pin site of his external skeletal fixator, with significant tissue destruction observed upon pin removal.
Findings:
- This case represents the first report of myiasis specifically involving an external skeletal fixation pin.
- A total of 105 maggots were extracted from the infected pin site.
Implications:
- The findings suggest that myiasis can occur in orthopedic pin sites, potentially through small, infected wounds adjacent to the hardware.
- Complete maggot eradication and appropriate antimicrobial therapy are crucial for managing this condition.
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