A 12-Year-old Boy with a Knee Infection

A 12-year-old boy, with no significant past medical history and no known drug allergies, presented to the emergency department with a deep laceration of his left knee after a fall on a ceramic plant pot in May 2013. A 10-cm long, L-shaped laceration heavily contaminated with soil and completely exposing the lateral femoral condyle was noted. He also was found to have a patella tendon avulsion (Fig. 1). The patient was oriented and comfortable with a blood pressure of 115/50 mm Hg, pulse of 68 beats/min and respiratory rate of 18 breaths/min. Blood tests showed the following mildly abnormal values: white cell count of 11.9 × 109/L (normal: 4–11 × 109/L), hemoglobin of 142 g/L (normal: 135–175 g/L), red cell distribution width of 11.9% (normal: 12%–15%), lymphocyte count of 3.87 × 109/L (normal: 1.50–3.50 × 109/L) and monocyte count of 1.27 × 109/L (normal: 0.2–0.8 × 109/L). The abnormal values from the biochemical analysis included: potassium of 3.3 mmol/L (normal: 3.5–5 mmol/L), phosphate of 0.55 mmol/L (normal: 1–2 mmol/L), alkaline aminotransferase of 74 U/L (normal: <35 U/L) and aspartate aminotransferase of 54 U/L (normal: <40 U/L). The wound was debrided and washed in the operating theater, followed by a second washout and patella tendon repair 48 hours later. Prophylactic antibiotic coverage for 10 days was provided with cephazolin. No microbial evidence of infection during the 2 surgeries was identified.