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Forearm Injury

Forearm Injury

Infection of the "simple" open fracture of the distal radius is a significant- but fortunately rare-complication of immobilizing musculoskeletal injuries of the upper extremity. Clinicians often underestimate the extent to which this type of fracture can be contaminated, particularly if the patient presents with a small puncture wound directly over the fractured distal radius that conceals the degree of contamination at the fracture site. If open fractures of the distal radius are simply washed out in the emergency department and temporarily splinted, overwhelming sepsis from clostridial myonecrosis may develop, leading to amputation. Such was the case with this patient, who had a "minor" open puncture over the fracture site. Clostridial (gas gangrene) infection occurred within 3 days after the injury and eventually necessitated amputation above the elbow. The lateral film shows air in the forearm, with evidence of gas gangrene. This case illustrates that even minor open fractures or musculoskeletal injuries can be a source of significant complications. Such injuries need to be treated with complete surgical debridement in the operating room.

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