Limb preservation after clostridial myonecrosis following internal fixation of a closed femoral fracture

A 24-year-old healthy man developed Clostridium perfringens myonecrosis wit h severe sepsis after plating of a closed femoral fracture. The leg could b e preserved by complete resection of the fascia from all muscle compartment s of the leg, including the pelvitrochanteric and the iliopsoas muscles, ra dical removal of necrotic muscle tissue, dissection of the para-aortal infr arenal lymphatics, daily debridements over 2 weeks, and systemic antibiotic therapy. The plate was removed because of a second septic episode followed by temporary stabilization with external fixation. After soft-tissue heali ng, plate fixation was carried out. The patient developed significant defic it of knee flexion (0 degrees/0/20 degrees) due to heterotopic ossification of the quadriceps femoris muscle that could be improved by partial resecti on of heterotopic bone formation. In the same operation the bony defect of the femur was filled with autologous bone graft. The fracture healed 10 mon ths after the accident. The patient can work full time in his previous prof ession as a mechanic, but again needs operative mobilization of the knee jo int, including open arthrolysis and quadriceps plasty.