Severe necrotising soft tissue infections in orthopaedic surgery.
OBJECTIVE
To review all cases of necrotising infection managed in the Department of Orthopaedic Surgery of Dunedin Hospital in New Zealand between 1989 and 1998.


METHODS
Hospital records were analysed for predisposing factors, clinical features, diagnostic results, treatment strategies, and outcomes.


RESULTS
13 cases (9 males and 4 females) of necrotising infection were identified. The mean age was 48 years (range, 8-76 years). Presenting symptoms included painful swelling, erythema, and necrosis. Most patients had predisposing factors and had received nonsteroidal anti-inflammatory drugs before presentation. 12 patients underwent surgical debridement including a total of 4 amputations. Septic shock developed in 9 patients who required dialysis for renal failure. Four patients died. The most common organisms identified were group A beta-haemolytic streptococci.


CONCLUSIONS
Severe necrotising infections require a high index of suspicion and rapid medical and surgical intervention to reduce the mortality and morbidity.
Theis
J C
JC
Department of Orthopaedic Surgery, Dunedin School of Medicine, PO Box 913, Dunedin, New Zealand. orthopaedic.surgery@stonebow.otago.ac.nz
Rietveld
J
J
Danesh-Clough
T
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009520:New Zealand / Q000453:epidemiology; D009985:Orthopedics; D012189:Retrospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery*; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology / Q000601:surgery*