Among the most common and devastating complications of an open fracture is infection, which has a reported incidence of 3–40%.1Brown P.W. The prevention of infection in open wounds.Clin Orthop Relat Res. 1973; 96: 42-50PubMed Google Scholar The orthopedic management of open fractures, particularly those that are severe, continues to be external fixation using metallic pins; this is associated with different complications, including infection.2Gustilo R.B. Merkow R.L. Templeman D. The management of open fractures.J Bone Joint Surg. 1990; 72: 299-304PubMed Google Scholar Typically bacterial in origin, most pin-site infections are treated effectively by pin removal and wound care with or without antibiotics, but other infectious complications, although rare, have been reported.1Brown P.W. The prevention of infection in open wounds.Clin Orthop Relat Res. 1973; 96: 42-50PubMed Google Scholar, 2Gustilo R.B. Merkow R.L. Templeman D. The management of open fractures.J Bone Joint Surg. 1990; 72: 299-304PubMed Google Scholar, 3Park P. Lodhia K.R. Eden S.V. Lewandrowski K.U. McGillicuddy J.E. Pin-site myiasis: a rare complication of halo orthosis.Spinal Cord. 2005; 43: 684-686Crossref PubMed Scopus (13) Google Scholar Recently, there have been an increasing number of reports about myiasis as a complication of fracture treatment by means of external fixation.3Park P. Lodhia K.R. Eden S.V. Lewandrowski K.U. McGillicuddy J.E. Pin-site myiasis: a rare complication of halo orthosis.Spinal Cord. 2005; 43: 684-686Crossref PubMed Scopus (13) Google Scholar, 4Paris L.A. Viscarret M. Uban C. Vargas J. Rodriguez-Morales A.J. Pin-site myiasis: a rare complication of a treated open fracture of tibia.Surg Infect. 2008; 9: 403-406Crossref PubMed Scopus (10) Google Scholar, 5Verettas D.A. Chatzipapas C.N. Drosos G.I. Xarchas K.C. Staikos C. Chloropoulou P. et al.Maggot infestation (myiasis) of external fixation pin sites in diabetic patients.Trans R Soc Trop Med Hyg. 2008; 102: 950-952Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Myiasis is a condition in which a human being or other mammal is infected by Diptera larvae (maggots).6Konkol K.A. Longfield R.N. Powers N.R. Mehr Z. Wound myiasis caused by Cochliomyia hominivorax.Clin Infect Dis. 1992; 14: 366Crossref PubMed Scopus (10) Google Scholar Herein, we report the sixth case of pin-site myiasis, in a patient with a treated femoral fracture. A 32-year-old male, from Bejuquero, Falcón, located in north-western Venezuela, presented six years ago with an open fracture of the middle third of the femur after a motor-vehicle crash. He had multiple surgical corrections of the fracture, most recently with the insertion of an external skeletal fixator of the femur. One week after discharge, he presented again with a primary complaint of purulent secretion and maggots at one of the pin sites. At the pin site, mild inflammation of the peripheral tissue was evident, with a wound approximately 4 cm in diameter. The patient subsequently underwent debridement and irrigation of the lesion to force the maggots (in total 300) to come out of the wound. These were identified as Cochliomyia hominivorax (Figure 1). No bacterial infection was evident, but antimicrobial prophylaxis was given with intravenous oxacillin 1 g q16 h and intravenous ciprofloxacin 500 mg q12 h, both for seven days. After careful evaluation, it was decided not to remove the pin; the wound was covered with a small mosquito net, and repeated daily debridement and irrigation of the wound and close follow-up were carried out, with a successful clinical outcome for the patient. A pin-site infection of bacterial origin is treated by local wound care, systemic antibiotics and, sometimes, removal of the pin with placement at an alternative site.1Brown P.W. The prevention of infection in open wounds.Clin Orthop Relat Res. 1973; 96: 42-50PubMed Google Scholar, 2Gustilo R.B. Merkow R.L. Templeman D. The management of open fractures.J Bone Joint Surg. 1990; 72: 299-304PubMed Google Scholar, 3Park P. Lodhia K.R. Eden S.V. Lewandrowski K.U. McGillicuddy J.E. Pin-site myiasis: a rare complication of halo orthosis.Spinal Cord. 2005; 43: 684-686Crossref PubMed Scopus (13) Google Scholar Additionally, hyperbaric oxygen therapy would have a positive effect on the vascular perfusion, as has been reported with intramedullary nailed simple tibial shaft fractures.7Lindstrom T. Gullichsen E. Lertola K. Niinikoski J. Effects of hyperbaric oxygen therapy on perfusion parameters and transcutaneous oxygen measurements in patients with intramedullary nailed tibial shaft fractures.Undersea Hyperb Med. 1998; 25: 87-91PubMed Google Scholar Until recent years, parasitic infections have not been reported as a complication of the management of open fracture treatments and, although bacterial infections continue to be the most common infectious complication, the emergence of myiasis as another etiology should be considered, properly diagnosed, managed and prevented.6Konkol K.A. Longfield R.N. Powers N.R. Mehr Z. Wound myiasis caused by Cochliomyia hominivorax.Clin Infect Dis. 1992; 14: 366Crossref PubMed Scopus (10) Google ScholarTable 1 summarizes the major features of the five previously reported cases of pin-site myiasis found in the literature and this current report. This form of traumatic myiasis occurred as a result of the invasion of tissue by larvae deposited by flies in suppurating wounds, ulcers, or areas with decomposition and necrosis. From these cases, it is concluded that diabetes, immobilization, drug and alcohol abuse, poor hygiene and low immune status are predisposing factors for the development of pin-site myiasis, a rare but emerging infectious complication of external fixation for the treatment of fractures.3Park P. Lodhia K.R. Eden S.V. Lewandrowski K.U. McGillicuddy J.E. Pin-site myiasis: a rare complication of halo orthosis.Spinal Cord. 2005; 43: 684-686Crossref PubMed Scopus (13) Google Scholar, 4Paris L.A. Viscarret M. Uban C. Vargas J. Rodriguez-Morales A.J. Pin-site myiasis: a rare complication of a treated open fracture of tibia.Surg Infect. 2008; 9: 403-406Crossref PubMed Scopus (10) Google Scholar, 5Verettas D.A. Chatzipapas C.N. Drosos G.I. Xarchas K.C. Staikos C. Chloropoulou P. et al.Maggot infestation (myiasis) of external fixation pin sites in diabetic patients.Trans R Soc Trop Med Hyg. 2008; 102: 950-952Abstract Full Text Full Text PDF PubMed Scopus (12) Google ScholarTable 1Summary of pin-site myiasis cases reported in the literatureCaseReferenceYearCountryAge, SexAnatomical location of pin-site myiasisRemoval of the EBFBacterial co-infectionIdentified larvaeNumber of specimens extractedRisk factors and/or co-morbidities13Park P. Lodhia K.R. Eden S.V. Lewandrowski K.U. McGillicuddy J.E. Pin-site myiasis: a rare complication of halo orthosis.Spinal Cord. 2005; 43: 684-686Crossref PubMed Scopus (13) Google Scholar2005USA39, FHalo orthosis placed for the management of a gunshot wound to the neck, producing an extensive comminuted fracture involving the right C6–7 facet and extending to the lamina of C7YesNoDiptera larvae (maggots); no species identifiedSeveral, not specifiedDrug abuse, high-dose steroid use, poor care of pin site, lack of close follow-up24Paris L.A. Viscarret M. Uban C. Vargas J. Rodriguez-Morales A.J. Pin-site myiasis: a rare complication of a treated open fracture of tibia.Surg Infect. 2008; 9: 403-406Crossref PubMed Scopus (10) Google Scholar2008Venezuela32, MExternal skeletal fixation of an open fracture of the tibia after motor vehicle crash traumaYesYes: Providencia stuartii and Pseudomonas aeruginosaCochliomyia hominivorax105Alcohol and drug (crack cocaine) abuse, poor care of pin site, lack of close follow-up35Verettas D.A. Chatzipapas C.N. Drosos G.I. Xarchas K.C. Staikos C. Chloropoulou P. et al.Maggot infestation (myiasis) of external fixation pin sites in diabetic patients.Trans R Soc Trop Med Hyg. 2008; 102: 950-952Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar2008Greece67, FOpen reduction and internal fixation of a malleolar fractureYesNoMaggots; no species identifiedNot specifiedInsulin-dependent diabetes with hyperglycemia, neuropathic arthropathy, immobilization, poor care of pin site, lack of close follow-up45Verettas D.A. Chatzipapas C.N. Drosos G.I. Xarchas K.C. Staikos C. Chloropoulou P. et al.Maggot infestation (myiasis) of external fixation pin sites in diabetic patients.Trans R Soc Trop Med Hyg. 2008; 102: 950-952Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar2008Greece78, MExternal fixation of a trochanteric fracture of the femurNoNoMaggots; no species identifiedNot specifiedNon-insulin-dependent diabetes with hyperglycemia, mild anemia, low lymphocyte count and low protein serum levels55Verettas D.A. Chatzipapas C.N. Drosos G.I. Xarchas K.C. Staikos C. Chloropoulou P. et al.Maggot infestation (myiasis) of external fixation pin sites in diabetic patients.Trans R Soc Trop Med Hyg. 2008; 102: 950-952Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar2008Greece86, MExternal fixation of a trochanteric fracture of the femurNoNoMaggots; no species identifiedNot specifiedNon-insulin-dependent diabetes with hyperglycemia, mild anemia, low lymphocyte count and low protein serum levels6Current report2008Venezuela32, MExternal skeletal fixation of an open fracture of the femur after motor vehicle crash traumaNoNoCochliomyia hominivorax300Multiple previous surgical interventionsEBF = External bone fixation. Open table in a new tab EBF = External bone fixation. Conflict of interest: No conflict of interest to declare.