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Life- and limb-threatening infections following the use of an external fixator
J J Jauregui1, N Bor2, R Thakral3
1Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
Abstract:
External fixation is widely used in orthopaedic and trauma surgery. Infections around pin or wire sites, which are usually localised, non-invasive, and are easily managed, are common. Occasionally, more serious invasive complications such as necrotising fasciitis (NF) and toxic shock syndrome (TSS) may occur. We retrospectively reviewed all patients who underwent external fixation between 1997 and 2012 in our limb lengthening and reconstruction programme. A total of eight patients (seven female and one male) with a mean age of 20 years (5 to 45) in which pin/wire track infections became limb- or life-threatening were identified. Of these, four were due to TSS and four to NF. Their management is described. A satisfactory outcome was obtained with early diagnosis and aggressive medical and surgical treatment. Clinicians caring for patients who have external fixation and in whom infection has developed should be aware of the possibility of these more serious complications. Early diagnosis and aggressive treatment are required in order to obtain a satisfactory outcome.
Insights
Serious infections like necrotising fasciitis (NF) and toxic shock syndrome (TSS) can arise from external fixation pin sites. Early diagnosis and aggressive treatment are crucial for limb and life-threatening cases.
Area of Science:
- Orthopaedic Surgery
- Trauma Surgery
- Infectious Diseases
Background:
- External fixation is a common orthopaedic and trauma surgery technique.
- Pin or wire site infections are typically localized and easily managed.
- However, severe invasive complications like necrotising fasciitis (NF) and toxic shock syndrome (TSS) can occur.
Purpose of the Study:
- To review cases of limb- or life-threatening infections secondary to external fixation pin/wire sites.
- To describe the management and outcomes of these severe complications.
Main Methods:
- Retrospective review of patients undergoing external fixation between 1997 and 2012.
- Identification of patients with limb- or life-threatening pin/wire track infections.
Main Results:
- Eight patients (seven female, one male; mean age 20 years) developed severe infections.
- Four cases were attributed to toxic shock syndrome (TSS) and four to necrotising fasciitis (NF).
- Satisfactory outcomes were achieved with early diagnosis and aggressive medical/surgical intervention.
Conclusions:
- Clinicians must recognize the potential for severe complications from external fixation pin site infections.
- Prompt diagnosis and aggressive management are essential for favorable patient outcomes.
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