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.