# Delayed onset of Corynebacterium simulans infection following open reduction and internal fixation of a trimalleolar fracture

## TL;DR

A rare case of infection caused by Corynebacterium simulans after ankle surgery is reported, highlighting the importance of accurate diagnosis for unusual pathogens.

## Contribution

First reported case of C. simulans infection following open reduction and internal fixation of an ankle fracture.

## Key findings

- Corynebacterium simulans was identified as the causative agent using MALDI-TOF MS and 16S rRNA sequencing.
- The patient showed no signs of infection after 12 months of follow-up following targeted antibiotic treatment.
- The case highlights the importance of considering atypical pathogens in postoperative complications.

## Abstract

Surgical site infections (SSIs) following open reduction and internal fixation (ORIF) of ankle fractures can lead to significant disability. This case report emphasizes a unique instance of SSI caused by Corynebacterium simulans, following ORIF of a trimalleolar ankle fracture in a 55-year-old female patient. To our knowledge, this is the first reported case of C. simulans infection after ORIF in the literature. The pathogen was detected after surgical debridement, removal and sonication of the hardware, and identified through matrix assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing. Specific intravenous antibiotic regimen was administered for a total duration of 4 weeks. During the 12th month follow-up, the patient presented no signs of infection and an excellent clinical outcome. This case report underscores the need for alertness regarding atypical pathogens in postoperative complications and the critical role of precise microbial diagnosis in managing rare orthopaedic infections.