5- months exposed implant after osteosynthesis is not necessarily a problem: A case report of a distal tibia fracture

Q4 Medicine

Trauma Case Reports Pub Date : 2025-07-10 DOI:10.1016/j.tcr.2025.101222

Johanna Michel , Nermine Habib , Joseph M. Schwab , Angela Seidel

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引用次数: 0

Abstract

Case

A 66-year-old patient sustained a closed tibial fracture which was treated by minimal invasive plate osteosynthesis. She developed a skin necrosis at the contusion side one month after surgery. A free gracilis flap was performed for soft tissue coverage together with hardware replacement. The intraoperative histopathological examen showed no signs of infection. One out of four positive intraoperative cultures taken from bone samples was positive and was interpreted as contamination. That is why the prophylactic antibiotic therapy with Cefuroxime was stopped after 5 days. The gracilis flap developed a distal necrosis with exposure of hardware. As there were no signs of active nor systematic infection no antibiotics were administrated. Directive wound healing was performed with the skin substitute Nushield® which took 5 months.

After consolidation of the fracture, the plate was removed. Intraoperative cultures of bone samples during hardware removal, as well as sonication fluid culture of the plate, were negative.

Conclusion

This case challenges the paradigm that exposed osteosynthesis hardware is always contaminated by cutaneous bacteria.

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骨融合术后5个月暴露假体并不一定是个问题：胫骨远端骨折一例报告

病例1例66岁患者闭合性胫骨骨折，采用微创钢板接骨术治疗。手术后一个月，她的挫伤侧出现皮肤坏死。游离股薄肌皮瓣覆盖软组织，同时进行硬件更换。术中组织病理学检查未见感染迹象。从骨样本中提取的4个阳性术中培养物中有1个阳性，这被解释为污染。这就是为什么5天后停用头孢呋辛预防性抗生素治疗的原因。股薄肌瓣发生远端坏死并暴露硬体。由于没有活动性或系统性感染的迹象，所以没有使用抗生素。使用皮肤替代品Nushield®进行指导伤口愈合，耗时5个月。骨折巩固后，取下钢板。术中取出硬体时骨样本的培养以及板的超声液培养均为阴性。结论：本病例挑战了外露的骨固定硬件总是被皮肤细菌污染的范式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Trauma Case Reports Medicine-Emergency Medicine

CiteScore

0.60

自引率

0.00%

发文量

131

审稿时长

26 weeks

期刊介绍： Trauma Case Reports is the only open access, online journal dedicated to the publication of case reports in all aspects of trauma care and accident surgery. Case reports on all aspects of trauma management, surgical procedures for all tissues, resuscitation, anaesthesia and trauma and tissue healing will be considered for publication by the international editorial team and will be subject to peer review. Bringing together these cases from an international authorship will shed light on surgical problems and help in their effective resolution.