Forearm Injury

January 1, 2002
John F. Connolly, MD

Infection of the “simple” open fractureof the distal radius is a significant-but fortunately rare-complication ofimmobilizing musculoskeletal injuriesof the upper extremity. Cliniciansoften underestimate the extent towhich this type of fracture can be contaminated,particularly if the patientpresents with a small puncture wounddirectly over the fractured distal radiusthat conceals the degree of contaminationat the fracture site. If openfractures of the distal radius are simplywashed out in the emergency department and temporarily splinted, overwhelming sepsis fromclostridial myonecrosis may develop, leading to amputation.

Infection of the "simple" open fractureof the distal radius is a significant-but fortunately rare-complication ofimmobilizing musculoskeletal injuriesof the upper extremity. Cliniciansoften underestimate the extent towhich this type of fracture can be contaminated,particularly if the patientpresents with a small puncture wounddirectly over the fractured distal radiusthat conceals the degree of contaminationat the fracture site. If openfractures of the distal radius are simplywashed out in the emergency department and temporarily splinted, overwhelming sepsis fromclostridial 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 necessitatedamputation 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 asource of significant complications. Such injuries need to be treated with complete surgical debridementin the operating room.

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