Orthopaedic Complications of Meningococcemia
J. IVAN KRAJBICH, M.D., F.R.C.S.(C), C. R. HAMDY, M.D., F.R.C.S., (C) AND SHEILA HUBBARD, B.Sc.
The charts of 51 consecutive patients with a diagnosis of meningococcemia admitted at the Hospital for Sick Children in Toronto between 1982 and 1990 were retrospectively reviewed in order to evaluate the outcome of this disease with specific emphasis on the musculoskeletal complications.
Six patients died within the first 3 days of admission from multiorgan failure. Fourteen patients had significant orthopaedic complications. Five had aseptic polyarthritis that resolved with physiotherapy and anti-inflammatory drugs, one developed bilateral avascular necrosis of the femoral heads three months after discharge and eight required amputations for gangrenous extremities. These included four quadruple, three triple and one unilateral amputee. Bilateral below knee amputations were performed in five of these eight patients.
Stump complications that frequently necessitated further surgery developed in five patients. Prosthetic fitting was more difficult than in other traumatic cases.
From a surgical point of view, we advocate delay in the amputation until the level of necrosis becomes clearly demarcated.
Hospital for Sick Children, 555 University Avenue, Room S107, Toronto, Ontario, Canada M5G 1X8