Meningococcal purpura fulminans in children. II: Late orthopedic sequelae management

Nectoux, Éric; Mezel, Aurélie; Raux, Sébastien; Fron, Damien; Klein, Céline; Herbaux, B.

doi:10.1007/s11832-010-0285-3

Cited by 12 publications

(8 citation statements)

References 7 publications

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“…The role of epiphysiodesis in preventing recurrent deformity has also recently been highlighted by Nectoux et al 9,10 Varus deformity around the knee as a result of meningococcal infection is similar to that caused by Blount's disease, with a variable extent of medial tibial plateau involvement. Hemiplateau elevation and bone graft may be necessary to restore joint congruity.…”

Section: Discussionmentioning

confidence: 92%

The management of the orthopaedic sequelae of meningococcal septicaemia

Park

Bradish

2011

The Journal of Bone and Joint Surgery. British volume

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Septicaemia resulting from meningococcal infection is a devastating illness affecting children. Those who survive can develop late orthopaedic sequelae from growth plate arrests, with resultant complex deformities. Our aim in this study was to review the case histories of a series of patients with late orthopaedic sequelae, all treated by the senior author (CFB). We also describe a treatment strategy to address the multiple deformities that may occur in these patients. Between 1997 and 2009, ten patients (seven girls and three boys) were treated for late orthopaedic sequelae following meningococcal septicaemia. All had involvement of the lower limbs, and one also had involvement of the upper limbs. Each patient had a median of three operations (one to nine). Methods of treatment included a combination of angular deformity correction, limb lengthening and epiphysiodesis. All patients were skeletally mature at the final follow-up. One patient with bilateral below-knee amputations had satisfactory correction of her right amputation stump deformity, and has complete ablation of both her proximal tibial growth plates. In eight patients length discrepancy in the lower limb was corrected to within 1 cm, with normalisation of the mechanical axis of the lower limb. Meningococcal septicaemia can lead to late orthopaedic sequelae due to growth plate arrests. Central growth plate arrests lead to limb-length discrepancy and the need for lengthening procedures, and peripheral growth plate arrests lead to angular deformities requiring corrective osteotomies and ablation of the damaged physis. In addition, limb amputations may be necessary and there may be altered growth of the stump requiring further surgery. Long-term follow-up of these patients is essential to recognise and treat any recurrence of deformity.

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Section: Discussionmentioning

confidence: 92%

The management of the orthopaedic sequelae of meningococcal septicaemia

Park

Bradish

2011

The Journal of Bone and Joint Surgery. British volume

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“…«++» -двустороннее поражение, «+» -одностороннее поражение, «-» -отсутствие поражения. [9,10]. Ортопедические последствия менингококцемии могут быть ранними и поздними.…”

Section: результаты и обсуждениеunclassified

“…Ранние орто педические последствия наблюдаются на фоне нарушения кровообращения в виде тяжелых некробиотических изменений мягких тканей как проксимальных, так и дистальных отделов конечностей. При отторжении некротических масс формируются грубые рубцы мягких тканей, а при наличии глубоких дефектов кожи и мягких тканей может понадобиться некрэктомия с последующим пластическим закрытием кожного дефекта или ампутация дистальных сегментов конечностей [6,10].…”

Section: результаты и обсуждениеunclassified

Orthopaedic sequelae of meningococcemia in children: options for the correction of lower and upper limb deformities (preliminary message)

Garkavenko

Евгеньевич²,

Khodorovskaya

et al. 2020

Pediatr Traum Orthop Reconstr Surg

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Background. Мeningococcal infection with damage to various organs and systems, including the musculoskeletal system, causes growth plate dysfunction, which usually leads to the formation of orthopedic consequences, including axis deviation and/or limb length discrepancy. Aim. This study aimed to analyze the features of limb deformities and methods for their correction in children with consequences of meningococcemia. Materials and methods. The retrospective analysis was performed on patients with consequences of meningococcemia who were examined and surgically treated in the clinic between 2012 and 2018. A total of 12 patients (six boys and six girls) were included, with an age range of 215 years. The examination included clinical, X-ray, and physiological methods. Treatment methods consisted of a combination of angular deformity correction and limb lengthening. Results. In 12 patients, 76 growth plate arrests of long bones were found. Most frequently (17.1%), growth plate arrests of the distal femur and proximal tibia were observed, which resulted in limb shortening and/or axis deviation. For restoration of limb alignment in 10 (83.3%) patients, transosseous compression-distraction osteosynthesis was performed. For limb deformity correction, guided growth technique was applied by using eight-plate for temporary epiphysiodesis of active functioning part of the growth plate in four (33.3%) patients, whereas partial growth plate arrest resection with following epiphysiodesis was achieved in two (16.6%). Conclusions. Meningococcal septicemia leads to long bone growth plate dysfunction. The main complaints in this patient are limb shortening and their deformity. Along with the transosseous compression-distraction osteosynthesis technique, using the guided growth method by carrying out temporary epiphysiodesis of the remaining functioning part of the growth plate of damaged bone was appropriate.

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“…Soft tissue and bone infections at the distal portion of an amputation stump occurred in 17% at the mean of 7 years after the initial sepsis. Nectoux et al 12 reported a total of six stump revisions because of soft tissue coverage or to improve prosthetic wear in seven patients who had below knee amputations.…”

Section: The Longer Termmentioning

confidence: 99%

“…Nectoux et al 12 reported the outcome of 14/19 patients who developed at least 1 orthopaedic consequence after a mean of 2 years. The most common presentation was lower limb growth plate arrest in 8 patients involving 18 growth plates leading to limb length discrepancy in 5 patients and significant knee or ankle malalignment in 12 patients.…”

Section: The Longer Termmentioning

confidence: 99%

The skeletal consequences of meningococcal septicaemia

Monsell

2012

Arch Dis Child

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Meningococcal disease remains a leading cause of childhood mortality in the UK. Advances in resuscitation have resulted in survival of severely affected individuals and the long-term skeletal consequences are being increasingly recognised. The immediate management of the ischaemic limb in the context of a critically ill and haemodynamically unstable child is described and the indications for fasciotomy and amputation are considered. Long-term disability occurs as a consequence of limb malalignment and is often accompanied by significant injury to the soft tissue envelope. The function of surviving limbs can be enhanced using contemporary surgical techniques that involve realignment and lengthening. Amputees present specific difficulties due to the effect of remaining longitudinal growth on the function of the residual limb, and require surgical treatment that often continues throughout childhood. This overview considers the surgical algorithms that have evolved to treat these patients.

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Meningococcal purpura fulminans in children. II: Late orthopedic sequelae management

Cited by 12 publications

References 7 publications

The management of the orthopaedic sequelae of meningococcal septicaemia

The management of the orthopaedic sequelae of meningococcal septicaemia

Orthopaedic sequelae of meningococcemia in children: options for the correction of lower and upper limb deformities (preliminary message)

The skeletal consequences of meningococcal septicaemia

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