In August 2014, a 37 years-old woman was admitted to the surgical intensive care unit of our tertiary care center, because of an open Cauchoix III fracture of left tibia and fibula with major skin damages and soft tissue defects after a motorcycle injury. On admission, the patient was intubated and ventilated. Body temperature was 36 C. Heart rate and blood pressure were normal. Ionogram, blood cell count and C-reactive protein (CRP) were all within normal ranges whereas serum creatinine phosphokinase (CPK) level was increased to 697 UI/L secondary to muscular lysis. She underwent emergency surgery involving orthopedic, vascular and plastic surgical procedures. The treatment consisted in trimming and washing followed by centromedular tibial osteosynthesis, anterior tibial artery bypass, deep peroneal nerve graft and finally soleus muscle flap for covering soft tissue defects. In early 2015, she presented a subcutaneous collection of fluid located close to orthopedic screws which had developed during the previous four months. On 15 June 2015, she was readmitted because of an acute purulent discharge that had started four days earlier. Her body temperature was normal and laboratory investigations revealed inflammation markers such as slightly elevated CRP (7.5 mg/L) and moderate neutrophil polynucleosis (7.9 G/L). The orthopedic treatment consisted in the removal of two screws and washing. Five bacteriological specimens were sampled as recommended [1].
