Fracture-Related Infection Following Internal Fixation of an Open Segmental Tibial Fracture

A young male patient sustained a segmental tibial fracture, with a closed proximal-third component and an open middle-third fracture through which a bone spike had protruded. The traumatic wound was initially sutured under local anaesthesia following limited debridement, and the limb was immobilized in a plaster slab. Internal fixation was performed on day 8 using a proximal lateral anatomical plate with a medial cancellous screw and an 11-hole LC-DCP for the middle-third fracture. A discharging sinus developed approximately three weeks after injury and persisted despite repeated swab cultures and multiple antibiotics. A second swelling subsequently appeared near the distal end of the incision. A swab reportedly isolated Pseudomonas aeruginosa. At approximately 10 weeks, the patient presented with two discharging sinuses situated near opposite ends of the plate, suggesting extensive deep infection rather than a localized superficial process.

1. Labelled-leucocyte PET imaging demonstrated abnormal uptake along
2. A wide surgical exposure was undertaken to facilitate radical excision
3. Histopathological assessment
4. The limb was stabilized in plaster for approximately three months