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Suggest Treatment For Infection After A Broken Bone

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Posted on Fri, 18 Sep 2015
Question: hi I have been involved in a car accident resulting in trauma to my hand. The third metacarpal bone is broken and needs replace with a bone graft. I have been told that I have the bug Serratia marcescens. The doctors first gave me IV gentamicin and performed stablisation with pins. I was then sent home and placed on Bactrim DS awaiting for wound to heal and await final operation to take pins out and do the bone graft with fixation. When I had that operation (5 weeks later) I woke up to hear that there was still infection from Serratia marcescens and had moved into my bone and bone graft could not be done or the pins could not be taken out. I had 2 days of IV gentamicin in hospital and then released back on Bactrim DS. I am now currently awaiting for the infection to resolve so I can have the bone graft operation. Is there a more effective antibiotic than Bactrim DS to get rid of the bug out of my hand and bone?... Very worried that my hand might get amputated.I need a answer from infectious disease specialist and orthopedic hand specialist
doctor
Answered by Dr. Aashish Raghu (40 minutes later)
Brief Answer:
Urgent surgical debridement need. Joint replacement better option

Detailed Answer:
Hi there.

Thanks for the query.

I have read your query, reviewed your reports and understood your problem.

You have a severe infection of the hand. Bone graft cannot be done anytime soon because we need to save your hand first.

A thorough surgical debridement is needed to remove the dead and necrotic tissue otherwise you can be prone for sepsis.

You need to get a culture and sensitivity testing of the necrotic tissue to find the right antibiotic for this organism because not every Serratia marcescens respond to the same antibiotic. Better antibiotics are Metronidazole and Tinidazole.

Now your Doctor's would focus on eradicating the infection and once it sells the bone graft and possibly joint replacement is needed.

I hope I have answered your query.

I will be available to answer your follow up queries.

Thanking you.

Regards,

Dr. Aashish Raghu


Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Aashish Raghu (11 hours later)
Hi
Dr. Aashish XXXXXXX I forgot to tell you that there is a cement spacer between third metacarpal. I had two debridement cleans initially before they closed wound.
then waited 5 weeks and opened up again to remove pins and fixation when they discovered infection around cement spacer. they did another debridement clean and closed back up. they did a swab and it came back as Serratia marcescens.

Once infection is in the bone can it be eradicated?

I'm not sure about the sensitivity testing. there is a infectious disease team on the case but.one of the problems I have is that the bone and third metacarpal knuckle is badly damaged is in photos and pins are in place to hold that area.
the pins may be causing the to flare infection?
Thank you for your suggestions for joint replacement, Metronidazole and Tinidazole. Are these IV or oral? Bactrim had not worked in the first 5 weeks but might be pins etc..Any other suggestions from infectious disease specialist and your team would be much appreciated.

Thank you
doctor
Answered by Dr. Aashish Raghu (4 hours later)
Brief Answer:
Culture sensitivity needed

Detailed Answer:
Hi there.

Thanks for your follow up query.

Infection in the bone is difficult to radiate. This condition is called osteomyelitis. The pins can lead to persistence of infection but are not dangerous unless they have become loose and are slipping out, which is when they should be removed.

Sensitivity testing can be done with a swab of the discharge from the wound. The bacteria can be tested against various antibiotics and the best antibiotics which can kill or control it will be listed to you and your Doctor can choose accordingly the specific antibiotic instead of going for general antibiotics which can take more time, now side effects and no guarantee to proper healing.

Tinidazole and Metronidazole can be taken both orally and IV. In your case I would do a culture and sensitivity first before starting antibiotic so that I can give the right Medicine to fight this infection.

I hope I have answered your query.

Regards,

Dr. Aashish Raghu

Above answer was peer-reviewed by : Dr. Sonia Raina
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Answered by
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Dr. Aashish Raghu

Orthopaedic Surgeon

Practicing since :2011

Answered : 5447 Questions

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Suggest Treatment For Infection After A Broken Bone

Brief Answer: Urgent surgical debridement need. Joint replacement better option Detailed Answer: Hi there. Thanks for the query. I have read your query, reviewed your reports and understood your problem. You have a severe infection of the hand. Bone graft cannot be done anytime soon because we need to save your hand first. A thorough surgical debridement is needed to remove the dead and necrotic tissue otherwise you can be prone for sepsis. You need to get a culture and sensitivity testing of the necrotic tissue to find the right antibiotic for this organism because not every Serratia marcescens respond to the same antibiotic. Better antibiotics are Metronidazole and Tinidazole. Now your Doctor's would focus on eradicating the infection and once it sells the bone graft and possibly joint replacement is needed. I hope I have answered your query. I will be available to answer your follow up queries. Thanking you. Regards, Dr. Aashish Raghu