Infection after open fracture of the tibia in polytraumatized patient

Abstract

Open fractures of the shinbone are the most common open fractures of long bones, typically resulting from direct or indirect exposure to strong force. Open fractures of the shinbone are often encountered in the context of polytrauma. This case presents a 58-year-old patient who experienced polytrauma after falling from a crane at a height of approximately four meters, resulting in an open fracture of the shinbone classified as Gustilo grade III B and a head injury. Upon admission to the hospital, diagnostic and preoperative preparations were carried out. The patient underwent a surgical procedure, during which the open fracture of the shinbone was stabilized with an external skeletal fixator, and the wound was closed with primary sutures. Due to the head injury, the patient was transferred to the neurosurgery clinic. During postoperative treatment, the patient developed a high fever, prompting a consultation with the orthopedic specialist. Upon removal of the dressing and gauze, purulent secretion was observed between the primary sutures of the wound. Following suture removal, soil was found in the depth of the wound along with purulent secretion. The wound was thoroughly irrigated, and foreign material, including the soil, was removed. The wound was left open, and antibiotic therapy was prescribed (amp. Ceftriakson a 2,0 gr/24 h, amp. Amikacin a 1,0/gr, Metronidazol a 500mg/8h). The patient underwent daily dressing changes, leading to improvement. The wound healed by secondary intention. After the fracture healed and completion of physical therapy, the patient returned to their work and daily activities.