Mucor Osteomyelitis of the Distal Radius Necessitating Ulnocarpal Fusion

Tiourin, Ekaterina; Kanack, Melissa; Ng, Wendy K. Y.; Leis, Amber

doi:10.7759/cureus.12813

Cited by 4 publications

(2 citation statements)

References 10 publications

(26 reference statements)

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“…Case reports of mucormycotic FRI are rare and different treatment regimens are described [7,9]: Treatment suggestions included surgical debridement, systemic antifungal therapy and often amputation of affected lower limbs [10,11]. Case reports with limb salvage in well vascularized body regions such as the hand have also been reported [12]. Amputation was performed in more instances than not and seemed a possibility for our patient as well, considering the invasiveness of mucormycosis with bone and soft tissue destruction leading to high mortality [7,10,11,13].…”

Section: Discussionmentioning

confidence: 97%

Fracture-related infection of the lower limb caused by Mucor velutinosus: amputation or salvation?

Eijkenboom,

Militz,

Kern

et al. 2024

Preprint

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Purpose: Fracture-related infections caused by mucormycosis are rare and potentially fatal. Evidence-based experience with its treatment is limited and surgical management ranges from limb salvage to amputation, with indications not always clear. Case presentation: A 56-year-old woman was admitted after an aircraft accident, sustaining major trauma injuries, including a Gustilo-Anderson type III open ankle joint fracture. Following initial damage control surgery with external fixation, the patient developed a fracture-related infection in the ankle caused by Mucor velutinosus. Despite its invasive growth and tenacity, surgical debridement combined with systemic and local antifungal therapy led to remission in this immunocompetent patient. The ankle arthrodesis achieved bone union with a hexapod fixator 10 months post trauma. Conclusion: In the treatment of invasive mucormycosis, a multidisciplinary approach is necessary. Through apt diagnosis and thorough treatment by experienced surgeons, infectiologists and pathologists successful limb salvage may be attained in patients with an intact immune system and amputation can be prevented.

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Section: Discussionmentioning

confidence: 97%

Fracture-related infection of the lower limb caused by Mucor velutinosus: amputation or salvation?

Eijkenboom,

Militz,

Kern

et al. 2024

Preprint

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“…While the gastrocnemius flap is a reliable option for small to moderate peripatellar defects, larger wounds require free tissue transfer for coverage. 3,12 The decision to proceed with free tissue transfer was further confirmed after interrogation of the genicular vessels revealed that these vessels were suitable. Free tissue transfer permitted a more controlled inset of soft tissues over the critical area of concern in the patella and distal thigh.…”

Section: Discussionmentioning

confidence: 99%

Lower Extremity Salvage in a Diabetic Patient With Cutaneous Mucormycosis and COVID-19 After Open Patella Fracture

Hammoudi

Morar

Garbuzov

et al. 2022

TOJ

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Background: Cutaneous mucormycosis, while less common than sinonasal or pulmonary infections, can cause widespread tissue necrosis after seemingly innocuous encounters. The most common location of cutaneous mucormycosis is the extremities, and extensive infection has been reported after trauma or orthopedic procedures. Case Report: A 60-year-old female with poorly controlled type 2 diabetes mellitus sustained an open patella fracture after a fall. She underwent washout and internal fixation with cannulated screws and cable tension band wiring. The patient's recovery was complicated by asymptomatic coronavirus disease 2019 (COVID-19) infection and repeated wound dehiscence, with growth of Mucor species initially presumed to be a contaminant. Despite serial washout and debridement, repeat dehiscence and patella exposure were noted. Free tissue transfer to the genicular vessels was selected for coverage of the extensor tendon, patella, and fracture line. In repeat skin cultures, Mucor indicus and Staphylococcus epidermidis grew from the wound. Topical voriconazole and a 6-week course of intravenous isavuconazole and oral doxycycline were started when the Mucor cultures were identified. Conclusion: This case highlights an approach to an indolent mucormycosis infection in the skin over a patella fracture in a patient with poorly controlled diabetes mellitus, including the sequence of surgical care, debridement, and selection of antimicrobials. Major amputation and orthopedic revision were avoided. This patient also underwent successful free tissue transfer after testing positive for COVID-19.

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