Abstract

Purpura fulminans is a rare and extremely severe infection, mostly due to Neisseria meningitidis. Nineteen patients were followed up immediately after the initial multivisceral failure in order to diagnose late-onset orthopedic sequelae. We report our experience with these 19 patients, in light of our medical follow-up protocol and surgical management. Nineteen patients were referred for acute purpura fulminans between 1987 and 2005 to our institution and followed up prospectively until the present. We collected information on all diagnosed orthopedic sequelae, all surgical procedures performed, and the actual orthopedic outcome. Fourteen patients developed at least one orthopedic sequel after a mean of 2years delay, with a mean of 8.65years follow-up (range 3-22years). The most common presentation was lower limb physeal growth plate arrest in eight patients involving 18 growth plates, leading to five limb length discrepancies and 12 significant knee and/or ankle deviations. Patients were treated by completing epiphysiodesis in addition to limb lengthening and/or reaxation osteotomies, except for two patients, in which epiphysiolysis was performed. All outcomes are, to date, satisfactory, with both knee and ankle axes within the physiological range. Among the seven patients who underwent below-knee amputation, six needed stump revision because of skin conflict (4) or prosthetics misadaptation due to upper tibial varus (2). Regarding the upper limb, three patients presented with four cicatricial scar bands, one located on a ring finger, two at the first commissure, and one at the wrist (all were successfully treated by enlargement Z-plasties). Two patients developed hip avascular necrosis. It is important for children diagnosed with meningococcal purpura fulminans to be followed up closely starting from the very beginning by a pediatric orthopedic surgeon. It ensures that late-onset orthopedic sequelae will be diagnosed early. In accordance to the literature, this study highlights the high rate of lower limb epiphysiodesis, above all other types of sequelae. This study reports a possible link between purpura fulminans and avascular necrosis of the hip.

Highlights

  • Purpura fulminans is an extremely severe form of infection, mainly due to Neisseria meningitidis or meningococcus

  • We report our experience with these 19 patients, in light of our medical follow-up protocol and surgical management

  • This study reports a possible link between purpura fulminans and avascular necrosis of the hip

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Summary

Introduction

Purpura fulminans is an extremely severe form of infection, mainly due to Neisseria meningitidis or meningococcus. It has given the opportunity to follow these children frequently thereafter, offering the possibility to diagnose orthopedic sequelae almost as soon as they appeared It is not yet well known which pathophysiological processes take part in the development of growth arrest [3], there is little guidance in the literature regarding the management of late-onset orthopedic sequelae [4, 5]. Our aim in this retrospective study was to review the case histories in light of our medical follow-up protocol and surgical management in order to discuss what seems important to us regarding the improvement of long-term follow-up. We collected information on all diagnosed orthopedic sequelae, all surgical procedures performed, and the actual orthopedic outcome

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