Gas gangrene following implant removal after the union of a tibial plateau fracture: a case report

BACKGROUND: Gas gangrene is an invasive, fatal anaerobic infection that is characterized by acute, rapid evolution and high mortality. Gas gangrene is often secondary to open fractures with deep wounds but is extremely rare in the patients undergoing elective surgery. Implant removal is a common elective operation in orthopedics after the union of fractures, and the complications of this surgery include infection, nerve injury and re-fracture. However, to the knowledge of the authors, there is no report in the literature on gas gangrene following implant removal. Here, we present a case study of gas gangrene following the removal of an internal fixation device after the union of a tibial plateau fracture. CASE PRESENTATION: A 59-year-old man with a postoperative union of a left tibial plateau fracture after open reduction and internal fixation complained of severe pain in the wound region on the first morning after implant removal surgery, and the incision was severely swollen and filled with hemorrhagic content. On the second morning, the patient’s symptoms were aggravated progressively. The patient experienced delirium on the third morning after surgery, and a physical examination revealed subcutaneous crepitus extending along the length of the limb, and roentgenograms revealed the accumulation of gas in soft tissue. Gas gangrene was highly suspected, and the left femoral amputation was performed the following night at approximately 11 p.m. General supportive therapy and antibiotic therapy were given subsequently, and the patient was recovered and discharged after his vital signs were stable. CONCLUSIONS: Although gas gangrene is rare, its high mortality and disability indicate that we should pay attention to its prophylaxis, and strict aseptic techniques should be emphasized for even the most minor procedure.