The management of the orthopaedic sequelae of meningococcal septicaemia

Abstract

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.

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

“…Что касается верхних конечностей, то они у детей, перенесших менингококковый сепсис, по данным большинства авторов, поражаются реже, чем нижние конечности [12,17]. В нашем исследовании поражение верхних конечностей зарегистрировано только у 4 (33,3 %) больных.…”

“…Авторы также считают, что при укорочении одной из костей предплечья, обусловливающей формирование одноименной косорукости, удлинение и коррекцию деформации необходимо выполнять только на укороченной и деформированной кости, а по достижении коррекции деформации рекомендуют прибегать к эпифизеодезу на обеих костях для предотвращения рецидива деформации. При этом они допускают, что эпифизеодез может привести к значимому укорочению предплечья и необходимости повторного удлинения [17].…”

“…Belthur берцовой костей, завершали аналогичные вмешательства эпифизеодезом. Рецидива деформации за период наблюдения, который в среднем составил 66 мес., авторы не отметили [17]. В представленных наблюдениях в четырех случаях использована методика управляемого роста для профилактики рецидива деформации, коррекции длины малоберцовой кости при дисфункции зон роста большеберцовой кости (рис.…”

Paediatric Orthopaedic Diagnosis

“…34 Localized Gigantism of the Limbs aggressive destruction of the entire proximal femur with secondary hip dislocation ( Fig. Purpura fulminans, either due to meningococcemia or other pyogenic bacteria, often leads to multiple physeal arrests of the lower extremities which results in leg length discrepancies and angular deformities (Belthur et al 2005 ;Canavese et al 2010 ;Park and Bradish 2011 ). Purpura fulminans, either due to meningococcemia or other pyogenic bacteria, often leads to multiple physeal arrests of the lower extremities which results in leg length discrepancies and angular deformities (Belthur et al 2005 ;Canavese et al 2010 ;Park and Bradish 2011 ).…”

The skeletal consequences of meningococcal septicaemia

“…Park et al 18 reported the skeletal maturity review of 10 patients treated for growth plate arrest involving 27 sites, most commonly the proximal and distal tibia. The most common presentation was limb length discrepancy and angular deformity at the knee and ankle.…”