Clostridial Catastrophe in Orthopedics - A Case Report

We present a case of a 51-year-old gentleman admitted to the emergency department with a 2-day history of severe left forearm symptoms following a Gustillo-Anderson type II left both bone fracture sustained during a bicycle accident. Initially managed conservatively at an outside facility with an above-elbow backslab, his condition rapidly deteriorated, necessitating transfer to our institution. Adding complexity to his clinical presentation was his history of poorly controlled type 2 diabetes mellitus.

On arrival, the patient exhibited fever and pronounced limb abnormalities, including extensive swelling, brownish skin with oozing blisters, and subcutaneous crepitus spanning from wrist to elbow. Radiological imaging unequivocally identified gas within the forearm compartments, signifying a severe infection. A provisional diagnosis of gas gangrene was made, later confirmed by culture report through intraoperative sampling.

Gas gangrene was definitively diagnosed, prompting immediate emergency surgery. Extensive necrosis was discovered during the procedure, necessitating an above-elbow amputation for limb salvage. Unfortunately, postoperatively, the infection continued to advance, extending to the chest and neck regions. Expert consultations in cardiothoracic and general surgery led to further extensive surgical interventions, including complete glenohumeral disarticulation and fasciotomy over chest for surgical emphysema. Microbiological analysis identified Clostridium perfringens, Escherichia coli, and Enterococcus as causative organisms. Aggressive antibiotic therapy, repeated surgical debridement, and meticulous wound management ultimately resulted in a successful recovery. The patient was discharged 20 days after initial presentation, underscoring the critical importance of prompt recognition and multidisciplinary management in severe gas gangrene cases, particularly in patients with underlying medical comorbidities.