Generalized Tetanus Following Traditional Manipulation of an Open Supracondylar Humerus Fracture in a Child: A Rare...

Tetanus is an uncommon but potentially life-threatening infection in the era of widespread immunization. However, it continues to occur in developing regions, particularly following contaminated injuries and delayed access to appropriate medical care. We report a rare case of generalized tetanus developing after traditional manipulation of an open supracondylar humerus fracture in a child.

A 12-year-old boy sustained an open supracondylar fracture of the right humerus following trauma. Before receiving definitive treatment, local manipulation and massage of the injured limb were performed. Initial management at another healthcare facility included wound dressing and Kirschner wire fixation. Subsequently, the child presented to our tertiary care center with severe pain, trismus, and generalized muscle spasms consistent with generalized tetanus. He was admitted to the pediatric intensive care unit and managed with human tetanus immunoglobulin, intravenous metronidazole, diazepam-based spasm control, supportive care, and orthopedic supervision. During hospitalization, he developed autonomic instability characterized by labile hypertension and tachycardia, which was managed medically. He did not require mechanical ventilation. During the course of treatment, the fixation wires loosened and were displaced. Revision surgery and debridement were advised; however, consent was declined by the parents. Conservative treatment was therefore continued. After approximately 2 months of hospitalization, the patient recovered from tetanus, the wound healed satisfactorily, and the fracture united with malunion.

This case highlights the ongoing risk of tetanus following contaminated open fractures, particularly when definitive treatment is delayed, and traditional manipulation is undertaken. Early wound management, appropriate tetanus prophylaxis, timely surgical intervention, and public awareness regarding the hazards of untrained fracture treatment remain essential to prevent such potentially fatal complications.