Figure 1.

(A) 53-year-old man was involved in a motorcycle accident and sustained an open fracture on the left tibia. The patient reported having insulin-dependent diabetes. (A) AP and lateral radiographs showed a simple fracture of the distal tibia, but the degree of soft tissue involvement and severe contamination led the injury to be classified as Gustilo et al. grade 3A. (B) The patient was taken to the operating room (OR) for urgent irrigation and debridement, and immediate definitive fixation with a medial mini-fragment reduction plate and a reamed tibial intramedullary nail (IM). (C) Ten days after hospital discharge, the patient returned to the outpatient clinic complaining of pain in the operated leg and showing clear signs of acute FRI. (D) The patient was re-admitted to the hospital and taken to the operating room for wound irrigation and debridement. Samples were collected for culture. Due to the acute nature of the FRI, it was decided to initiate appropriate suppressive antibiotic therapy and maintain the IM implant. A negative pressure dressing was placed. (E) AP and lateral radiographs of the left leg taken 90 days after the second procedure showed uneventful healing of the fracture. (F) AP and lateral radiographs of the left leg after 2 years of follow-up showed no signs of infection and adequate healing of the soft tissues.