Amputation Following Meningococcal Septicaemia in Children: the Surgical Management of the Residual Limb
Volume 4 | Issue 2 | July-December 2018 | Page: 20-26 | Brigid M. Aherne, Fergal P. Monsell
DOI- 10.13107/ijpo.2018.v04i02.014
Authors: Brigid M. Aherne, Fergal P. Monsell [1]
Medical Student, University of Bristol, [1] Consultant Orthopaedic Surgeon, Bristol Royal Hospital for Children, Bristol, England, United Kingdom.
Address of Correspondence
Mr. Fergal P. Monsell,
Bristol Royal Hospital for Children, Upper Maudlin St, Bristol BS2 8BJ, England, United Kingdom.
E-mail: Fergal.Monsell@UHBristol.nhs.uk
Abstract
Background: Meningococcal septicaemia is a potentially life-threatening disease and remains the most common infective cause of mortality in the UK. Improvements in healthcare have led to early recognition and treatment, and a decrease in mortality. As more children now survive the initial acute illness, the long-term musculoskeletal consequences have become more prevalent. These include growth plate injury, tissue loss and amputation. Patients with limb loss present specific difficulties due to the effect of remaining longitudinal growth on the function of the residual limb, and often require surgical treatment that continues throughout childhood.
Patients and Methods: This case series reviews the histories of 13 children who underwent amputation as a complication of meningococcal septicaemia. All patients attend a specialist clinic and our experience in the management of the residual limb is described.
Results: Thirteen patients, with a mean age of 16 months at the onset of meningococcal septicaemia, required amputation in the management of the skeletal consequences of the infection. Revision surgery was necessary for all 13 patients and involved management of bone overgrowth, growth arrest, scar and soft tissue contracture, neuroma development, and infection. The details of our approach to each of these complications is described.
Conclusion: Due to improvements in diagnosis and initial management, a significant proportion of patients are surviving infantile meningococcal septicaemia. Many develop musculoskeletal consequences including amputation, and this case series serves to increase knowledge in the complex managements of the residual limb in these patients.
Keywords: Amputation, meningococcal septicaemia, residual limb
References
1. Paize F, Playfor SD. Improvements in the outcome of children with meningococcal disease. Crit Care 2007;11:172.
2. Maat M, Buysse CM, Emonts M, Spanjaard L, Joosten KF, De Groot R, et al. Improved survival of children with sepsis and purpura: Effects of age, gender, and era. Crit Care 2007;11:R112.
3. Nectoux E, Mezel A, Raux S, Fron D, Maillet M, Herbaux B. Meningococcal purpura fulminans in children: I. Initial orthopedic management. J Child Orthop 2010;4:401-7.
4. de Kleijn ED, Hazelzet JA, Kornelisse RF, de Groot R. Pathophysiology of meningococcal sepsis in children. Eur J Pediatr 1998;157:869-80.
5. Davies MS, Nadel S, Habibi P, Levin M, Hunt DM. The orthopaedic management of peripheral ischaemia in meningococcal septicaemia in children. J Bone Joint Surg Br 2000;82:383-6.
6. Belthur MV, Bradish CE, Gibbons PJ. Late orthopaedic sequelae following meningococcal septicaemia. J Bone Joint Surg Br 2005;87:236-40.
7. Booy R, Habibi P, Nadel S, de Munter C, Britto J, Morrison A, et al. Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery. Arch Dis Child 2001;85:386-90.
8. Monsell FP, McBride AR, Barnes JR, Kirubanandan R. Angular deformity of the ankle with sparing of the distal fibula following meningococcal septicaemia: A case series involving 14 ankles in ten children. J Bone Joint Surg Br 2011;93:1131-3.
9. Monsell F. The skeletal consequences of meningococcal septicaemia. Arch Dis Child 2012;97:539-44.
10. Nectoux E, Mezel A, Raux S, Fron D, Klein C, Herbaux B. Meningococcal purpura fulminans in children. II: Late orthopedic sequelae management. J Child Orthop 2010;4:409-16.
11. Park DH, Bradish CF. The management of the orthopaedic sequelae of meningococcal septicaemia: Patients treated to skeletal maturity. J Bone Joint Surg Br 2011;93:984-9.
12. Buysse CM, Oranje AP, Zuidema E, Hazelzet JA, Hop WC, Diepstraten AF, et al. Long-term skin scarring and orthopaedic sequelae in survivors of meningococcal septic shock. Arch Dis Child 2009;94:381-6.
13. Nogi J. Physeal arrest in purpura fulminans − A report of 3 cases. J Bone Joint Surg Am 1989;71:929-31.
14. Wheeler JS, Anderson BJ, De Chalain TM. Surgical interventionsin children with meningococcal purpura fulminans − A review of 117 procedures in 21 children. J Pediatr Surg 2003;38: 597-603.
15. Grogan DP, Love SM, Ogden JA, Millar EA, Johnson LO. Chondro-osseous growth abnormalities after meningococcemia − A clinical and histopathological study. J Bone Joint Surg Am 1989;71:920-8.
How to Cite this Article: Aherne BM, Monsell FP | Amputation Following Meningococcal Septicaemia in Children: the Surgical Management of the Residual Limb | July-December 2018; 4(2): 20-26. |