Catastrophic osteomyelitis following percutaneous wire fixation of a distal radial fracture: a cautionary tale of poor patient selection followed by surgical mishap.
We present a case of distal radius fracture. Several sequential unfortunate events resulted in a poor outcome. The patient was poorly selected because the degree of early dementia was not fully appreciated, due to intermittent periods of lucidity. Having elected to treat this distal radius fracture with Kirschner wires, a wire snapped during the procedure and was deemed safe to leave within the medullary cavity. Subsequently, the patient was left in a cast for 4 weeks without regular pin site inspection. When the cast was removed a gross osteomyelitis had developed. This series of events, led to unnecessary morbidity and extended the immobilisation time with reduced wrist function. This case highlights the importance of careful patient selection, surgical tactics and continuity of care.
Department of Trauma and Orthopaedics, Royal Victoria Infirmary, Newcastle upon Tyne, UK. dwshields@gmail.com
David W
DW
Shields
David W
DW
Elson
Martin
M
Marsh
Andrew C
AC
Gray
D000369:Aged, 80 and over; D001864:Bone Wires; D003704:Dementia / Q000150:complications; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects*; D006801:Humans; D010019:Osteomyelitis / Q000382:microbiology* / Q000628:therapy; D018579:Patient Selection; D011885:Radius Fractures / Q000150:complications / Q000601:surgery*; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000628:therapy