Abstract

Osteomyelitis is common following open fractures and is accentuated in the presence of devices like prosthetics or external fixators. It is most commonly caused by gram-positive bacteria. Fungal infections are rarely reported. This is the report of a case of zygomycosis of bone in an open fracture of femur with exposed knee joint with external fixator and proximal femoral nailing.

• 1.   Kremers HM, Nwojo ME, Ransom JE, Wood-Wentz CM, Melton LJ 3rd, Huddleston PM 3rd. Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009. J Bone Joint Surg Am. 2015;97(10):837–45.
• 2.   Peltola H, Pääkkönen M. Acute osteomyelitis in children. N Engl J Med. 2014;370(4):352–60.
• 3.   Mylona E, Samarkos M, Kakalou E, Fanourgiakis P, Skoutelis A. Pyogenic vertebral osteomyelitis: a systematic review of clinical characteristics. Semin Arthritis Rheum. 2009;39(1):10–7.
• 4.   Kohli R, Hadley S. Fungal arthritis and osteomyelitis. Infect Dis Clin North Am. 2005;19(4):831–51.
• 5.   Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. 1984;24(8):742–6.
• 6.   Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;(243):36–40.
• 7.   Zalavras CG. Prevention of infection in open fractures. Infect Dis Clin North Am. 2017;31(2):339–52.
• 8.   Ostermann PA, Seligson D, Henry SL. Local antibiotic therapy for severe open fractures. A review of 1085 consecutive cases. J Bone Joint Surg Br. 1995;77(1):93–7.
• 9.   Pollak AN, Jones AL, Castillo RC, Bosse MJ, MacKenzie EJ; LEAP Study Group. The relationship between time to surgical debridement and incidence of infection after open high-energy lower extremity trauma. J Bone Joint Surg Am. 2010;92(1):7–15.
• 10.   Patzakis MJ, Wilkins J, Moore TM. Use of antibiotics in open tibial fractures. Clin Orthop Relat Res. 1983;(178):31–5.
• 11.   Gosselin RA, Roberts I, Gillespie WJ. Antibiotics for preventing infection in open limb fractures. Cochrane Database Syst Rev. 2004;(1):CD003764.
• 12.   Dellinger EP, Miller SD, Wertz MJ, Grypma M, Droppert B, Anderson PA. Risk of infection after open fracture of the arm or leg. Arch Surg. 1988;123(11):1320–7.
• 13.   Kindsfater K, Jonassen EA. Osteomyelitis in grade II and III open tibia fractures with late debridement. J Orthop Trauma. 1995;9(2):121–7.
• 14.   McNeil JC, Vallejo JG, Hulten KG, Kaplan SL. Osteoarticular infections following open or penetrating trauma in children in the post-community-acquired methicillin-resistant Staphylococcus aureus era: the impact of Enterobacter cloacae. Pediatr Infect Dis J. 2018;37(12):1204–10.
• 15.   American Society of Plastic Surgeons. Evidence-based clinical practice guideline: chronic wounds of the lower extremity [Internet]. American Society of Plastic Surgeons; 2007.
• 16.   Pääkkönen M, Kallio MJ, Kallio PE, Peltola H. Sensitivity of erythrocyte sedimentation rate and C-reactive protein in childhood bone and joint infections. Clin Orthop Relat Res. 2010;468(3):861–6.
• 17.   American Society of Plastic Surgeons. Evidence-based clinical practice guideline: chronic wounds of the lower extremity [Internet]. American Society of Plastic Surgeons; 2007
• 18.   Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers. A clinical sign of underlying osteomyelitis in diabetic patients. JAMA. 1995;273(9):721–3.
• 19.   Senneville E, Melliez H, Beltrand E, et al. Culture of percutaneous bone biopsy specimens for diagnosis of diabetic foot osteomyelitis: concordance with ulcer swab cultures. Clin Infect Dis. 2006;42(1):57–62.
• 20.   Gross T, Kaim AH, Regazzoni P, Widmer AF. Current concepts in posttraumatic osteomyelitis: a diagnostic challenge with new imaging options. J Trauma. 2002;52(6):1210–9.
• 21.   Pineda C, Espinosa R, Pena A. Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy. Semin Plast Surg. 2009;23(2):80–9.
• 22.   Kapoor A, Page S, LaValley M, Gale DR, Felson DT. Magnetic resonance imaging for diagnosing foot osteomyelitis: a meta-analysis. Arch Intern Med. 2007;167(2):125–32.
• 23.   Termaat MF, Raijmakers PG, Scholten HJ, Bakker FC, Patka P, Haarman HJ. The accuracy of diagnostic imaging for the assessment of chronic osteomyelitis: a systematic review and meta-analysis. J Bone Joint Surg Am. 2005;87(11):2464–71.
• 24.   Arendrup MC. Candida and candidaemia. Susceptibility and epidemiology. Dan Med J. 2013;60(11):B4698.
• 25.   Spellberg B, Walsh TJ, Kontoyiannis DP, et al. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis. 2009;48(12):1743–51.
• 26.   Levy E, Bia MJ. Isolated renal mucormycosis: case report and review. J Am Soc Nephrol. 1995;5(12):2014–9.
• 27.   Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019;19(12):e405–21.
• 28.   Sun HY, Aguado JM, Bonatti H, et al. Pulmonary zygomycosis in solid organ transplant recipients in the current era. Am J Transplant. 2009;9(9):2166–76.
• 29.   Sun HY, Forrest G, Gupta KL, et al. Rhino-orbital-cerebral zygomycosis in solid organ transplant recipients. Transplantation. 2010;90(1):85–92.
• 30.   Tice AD, Hoaglund PA, Shoultz DA. Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy. Am J Med. 2003;114(9):723–8.
• 31.   Conterno LO, da Silva Filho CR. Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst Rev. 2009;(3):CD004439.

Data Sharing Statement

Funding