Fracture fixation complicated by Propionibacterium

An otherwise health man in his 60s sustained this fracture.

It was treated by open reduction and internal fixation

Four months later he was having pain and stiffness. 

Seven months later his symptoms were worse.

He presented to a different physician who removed his hardware. After that his films looked like this.

He presented for shoulder arthroplasty. There was no clinical evidence of infection. All labs were normal. There was no cloudy joint fluid or synovitis. We sent multiple tissue samples for cultures and proceeded to perform a total shoulder. 

After surgery he was placed on the yellow protocol. A week later he was changed to the red protocol because four of his specimens grew out Propionibaterium. Three of the positive cultures were from the humeral bone and one from the synovium. Two of the cultures had two different colony types.


Comment: While he is doing very well at two months after his surgery, only time will tell if his infection was successfully managed by his surgery and antibiotics.

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