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[Clostridium perfringens infection following intramedullary nailing of an open femur shaft fracture].

In a 47-year old patient, clostridial bacteraemia and local gas gangrene developed following osteosynthesis of a penetrating femoral fracture by a medullary nail. The operation had been performed in a post-injury interval of 14 days. The first clinical symptoms did not appear until 6 days after surgery. Operative treatment by large local incisions, debridement and drainage with the medullary nail left in situ accompanied by administration of penicillin G resulted in recovery. In the case presented here, local haematoma and debris due to the osteosynthesis procedure had probably induced a proliferation of clostridia leading to gas gangrene. The delay in development of signs and symptoms and the benign appearance of the wound resulted in delay in early diagnosis and appropriate treatment of this potentially life-threatening entity. Ultrasound proved to be a valuable tool in the evaluation of local changes. Even in performed in an appropriate postinjury interval, medullary nailing bears a potential risk of inducing a clostridial infection, so that the indication must be very strict.