RT Journal Article
SR Electronic
T1 The skeletal consequences of meningococcal septicaemia
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 539
OP 544
DO 10.1136/archdischild-2011-301295
VO 97
IS 6
A1 Fergal Monsell
YR 2012
UL http://adc.bmj.com/content/97/6/539.abstract
AB 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.