Toxic shock syndrome in patients with external fixators

Toxic shock syndrome (TSS), first described by Todd et al. in 1978, can be a life-threatening entity. Familiarity with the pathogenesis and clinical presentation of TSS may help achieve early diagnosis and prompt appropriate intervention. TSS is not a septicemia, but a toxemia. The most extensively described pathogenesis involves a focus of specific Staphylococcus aureus strains capable of producing an exotoxin (TSST-1). We report two patients who developed TSS while in external fixators and describe their initial symptoms, management, and subsequent problems. This report will serve to alert pediatric orthopaedic surgeons to this entity and enable them to recognize its rather precipitous presentation and initiate appropriate treatment.