5- months exposed implant after osteosynthesis is not necessarily a problem: A case report of a distal tibia fracture
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...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-08-01
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| Series: | Trauma Case Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352644025000998 |
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| author | Johanna Michel Nermine Habib Joseph M. Schwab Angela Seidel |
| author_facet | Johanna Michel Nermine Habib Joseph M. Schwab Angela Seidel |
| author_sort | Johanna Michel |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-afc0de0ecc254b6cb5352099eb24b87e |
| institution | Kabale University |
| issn | 2352-6440 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Trauma Case Reports |
| spelling | doaj-art-afc0de0ecc254b6cb5352099eb24b87e2025-08-20T03:36:19ZengElsevierTrauma Case Reports2352-64402025-08-015810122210.1016/j.tcr.2025.1012225- months exposed implant after osteosynthesis is not necessarily a problem: A case report of a distal tibia fractureJohanna Michel0Nermine Habib1Joseph M. Schwab2Angela Seidel3Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, SwitzerlandSwiss Diabetic Foot Centers, Fribourg, SwitzerlandDepartment of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, SwitzerlandDepartment of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Switzerland; Corresponding author at: Head of Foot and Ankle Surgery, Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Chemin Des Pensionnats 2-6, 1708 Fribourg, Switzerland.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.http://www.sciencedirect.com/science/article/pii/S2352644025000998 |
| spellingShingle | Johanna Michel Nermine Habib Joseph M. Schwab Angela Seidel 5- months exposed implant after osteosynthesis is not necessarily a problem: A case report of a distal tibia fracture Trauma Case Reports |
| title | 5- months exposed implant after osteosynthesis is not necessarily a problem: A case report of a distal tibia fracture |
| title_full | 5- months exposed implant after osteosynthesis is not necessarily a problem: A case report of a distal tibia fracture |
| title_fullStr | 5- months exposed implant after osteosynthesis is not necessarily a problem: A case report of a distal tibia fracture |
| title_full_unstemmed | 5- months exposed implant after osteosynthesis is not necessarily a problem: A case report of a distal tibia fracture |
| title_short | 5- months exposed implant after osteosynthesis is not necessarily a problem: A case report of a distal tibia fracture |
| title_sort | 5 months exposed implant after osteosynthesis is not necessarily a problem a case report of a distal tibia fracture |
| url | http://www.sciencedirect.com/science/article/pii/S2352644025000998 |
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