Orthopaedic sequelae of meningococcal septicemia.
The records of 143 patients admitted with a diagnosis of meningococcal septicemia were reviewed to identify vascular, cutaneous, and osseous sequelae. During the acute phase of the disease there were 21 deaths and 17 patients lost tissue. Thirty-six digits were allowed to autoamputate and six surgical amputations were performed. Each of the latter developed physeal growth arrests proximal to the level of amputation. Four patients underwent fasciotomies for compartment syndrome. Two of these patients had absent distal pulses and at surgery were found to have nonviable limb segments; the authors conclude that fasciotomy is rarely indicated. Sixteen patients were identified with a total of 41 growth arrests. Twenty-three of these occurred under areas of cutaneous scarring and were diagnosed 2 to 9 years after the index admission. The authors believe that patients requiring débridement and/or skin grafting of areas of skin necrosis should be reviewed regularly during the growth period to identify physeal damage at a stage when less complex surgery may be indicated.
Bache
Christopher E
CE
Department of Orthopaedics, Birmingham Children's Hospital, Birmingham, UK. edsarahbache@aol.com
Torode
Ian P
IP
D017677:Age Distribution; D016470:Bacteremia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008589:Meningococcal Infections / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D009140:Musculoskeletal Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D012871:Skin Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D017741:Survivors