THE ORTHOPAEDIC MANAGEMENT OF PERIPHERAL ISCHAEMIA IN CHILDHOOD MENINGOCOCCAL SEPTICAEMIA

Introduction: The aim was to evaluate the outcome of orthopaedic intervention in children who sustained peripheral ischaemiafrom meningococcal septicaemiaand assess the benefit of fasciotomieswithin this group. Methods: From 1994–2004 there were 190 admissions to paediatric intensive care unit(PICU) with meningococcal septicaemia. 12 had significant Orthopaedic/Plastic Surgical input. Case notes were examined to establish admission patterns, limb progress, operative intervention and outcomes. All presented with viral symptoms and developed rapidly spreading purpuric rashes within 24hours. 8 were admitted from A&E, 4 transferred from other hospitals. All received antibiotics, fluid resuscitation, ventilation and inotropic support. One child died within 14 hours of PICU admission. Haemofiltration was used in 11 children (mean 14.8 days, range 2–60 days). We were able to follow up 8 of the survivors clinically. Results: All children had surgical treatment. 9 children had one or more amputations. Two children did not require amputations. Seven of the 12 children had fasciotomiesperformed (mean 34 hours after admission, range 2–96 hours). The child who died had multiple fasciotomiesat 9 hours post admission. The remaining children had varying amputations. The other five children did not have fasciotomies. Of these one child did not require any amputations, three children had partial amputationof a single limb and one child had partial amputationsof two limbs.. All five within this group required additional split-skin grafts. 8 children were followed clinically. 7 were mobile with walking aids with a mean of 1.3 prosthetic lower limbs (range 0–2). Conclusion: There is no evidence from our study that early fasciotomiesare detrimental to survival, limb function or subsequent wound healing after definitive amputation. In other published series fasciotomyhas been advocated within 24hours. In 2 of 7 patient, after fasciotomythe demarcation level receded distally leading to more distal amputationlevels.