Life- and limb-threatening infections following the use of an external fixator.
External fixation is widely used in orthopaedic and trauma surgery. Infections around pin or wire sites, which are usually localised, non-invasive, and are easily managed, are common. Occasionally, more serious invasive complications such as necrotising fasciitis (NF) and toxic shock syndrome (TSS) may occur. We retrospectively reviewed all patients who underwent external fixation between 1997 and 2012 in our limb lengthening and reconstruction programme. A total of eight patients (seven female and one male) with a mean age of 20 years (5 to 45) in which pin/wire track infections became limb- or life-threatening were identified. Of these, four were due to TSS and four to NF. Their management is described. A satisfactory outcome was obtained with early diagnosis and aggressive medical and surgical treatment. Clinicians caring for patients who have external fixation and in whom infection has developed should be aware of the possibility of these more serious complications. Early diagnosis and aggressive treatment are required in order to obtain a satisfactory outcome.
Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
J J
JJ
Jauregui
Emek Medical Center, Afula, Israel.
N
N
Bor
University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
R
R
Thakral
Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
S C
SC
Standard
Paley Advanced Limb Lengthening Institute, West Palm Beach, Florida, USA.
D
D
Paley
Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
J E
JE
Herzenberg
D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening / Q000009:adverse effects / Q000295:instrumentation*; D001858:Bone Nails / Q000009:adverse effects; D001864:Bone Wires / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D016267:External Fixators / Q000009:adverse effects*; D019115:Fasciitis, Necrotizing / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
bone lengthening; complications; external fixation; infection; necrotising fasciitis; toxic shock syndrome