Orthopaedic sequelae of childhood meningococcemia: management considerations and outcome

Background: Patients who survive the initial acute phase of fulminantmeningococcemia are at increased risk for serious orthopaedic complications. This report describes our experience with purpura fulminans related to meningococcemia, with emphasis on musculoskeletal sequelae and their treatment. Methods: We retrospectively reviewed the cases of forty-eight patients (twenty-two boys and twenty-six girls) who sur-vived the acute phase of meningococcal septicemia and developed musculoskeletal sequelae. Early sequelae required surgical treatment within six months after the onset of sepsis and were primarily amputations. Late sequelae required surgical management six months or more following the initial infection and included growth disturbances, stump over-growth, scar contractures, and soft-tissue and bone infections. Results: The mean age at the onset of sepsis (and standard deviation) was 2.6 ± 3.0 years, and the mean duration of follow-upwas11.7±5.1 years. Themeannumber of surgical procedures requiredwas4.4±2.9 per patient. Early sequelae included amputations at a variety of levels. Upper-extremity amputations were less frequent than lower-extremity ampu-tations. Growth disturbances in the upper extremities were less frequent than growth disturbances in the lower extremities. Stump overgrowth occurred in only eleven patients (23%) with a lower-extremity amputation. The prevalence of scar contractures in the upper extremities was similar to that in the lower extremities. Eight patients (17%) acquired soft-tissue and bone infections at the distal portion of the amputation stump, at a mean of 7.2 ± 5.4 years after the initial sepsis