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Clostridium septicum gangrene complicating a closed femoral fracture
1Department of Orthopaedic Surgery, Katholieke Universiteit Leuven, Pellenberg, Belgium.
Abstract:
One of the basic principles of orthopedic surgery is that gas gangrene does not develop in closed fractures. That there are exceptions to this rule is demonstrated by the following report of an extremely rare case. Clostridium septicum myonecrosis developed after surgical treatment of a closed femoral fracture in a fit 45-year-old man, treated by antibiotics. The patient survived after having a right hip disarticulation and administration of high doses of intravenous penicillin. Prophylactically administered cephalosporins failed to prevent the Clostridial infection.
Insights
Gas gangrene, a rare complication, can occur even in closed fractures despite surgical treatment. This case highlights an exception where Clostridium septicum myonecrosis developed post-surgery, requiring hip disarticulation.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Gas gangrene (myonecrosis) is typically associated with open fractures.
- Closed fractures are generally considered a low-risk environment for Clostridial infections.
Observation:
- A 45-year-old male developed Clostridium septicum myonecrosis after surgical repair of a closed femoral fracture.
- The patient received antibiotic treatment, including prophylactic cephalosporins, which failed to prevent the infection.
Findings:
- This case represents an extremely rare instance of gas gangrene in a closed fracture setting.
- High-dose intravenous penicillin was crucial in treating the Clostridial infection.
Implications:
- The findings challenge the established principle that closed fractures preclude gas gangrene development.
- This case underscores the importance of vigilance for rare infections in orthopedic surgery.
- Further research may be needed to understand risk factors and optimal prophylaxis for Clostridial infections in specific orthopedic contexts.