The orthopaedic implications of purpura fulminans

The syndrome of purpura fulminans has frequently been reported in the surgical and pediatric literature, but rarely in the orthopaedic literature. The mortality rate has decreased dramatically from early reports of approximately 90 per cent to more recent reports of 18 per cent. Amputation of a portion of the involved extremities, however, is usually required in the patients who survive. Over a twelve-month period, we treated four patients who had purpura fulminans, with resultant vasospasm and secondary ischemic gangrene. In three of the patients the syndrome developed following a one to two-day febrile illness, and in one, following varicella. All four patients survived, but two required a bilateral lower-limb amputation; one, a Syme amputation and a partial hand amputation; and one, an amputation of the fore part of the foot. Autoamputation of multiple fingertips and toes occurred in two of the four patients.