Toxic shock syndrome as a complication of orthopaedic surgery

Toxic shock syndrome (TSS) was initially described by Todd et al. in 1978. TSS as a complication of orthopaedic surgery was reported in 1984. There have been previously a total of nine cases of TSS reported in orthopaedic patients. These patients presented at an average of 13 days postoperatively compared to 2 days for general surgical patients. Patients with external fixators, however, presented an average of 25 days postoperatively. Menstrual TSS and nonmenstrual TSS present similarly; however, the fatality rate is reported as 10 and 50%, respectively. There was a 27% case fatality rate in orthopaedic patients. Because TSS is not a septicemia but a toxemia, the treatment depends on aggressive hemodynamic stabilization rather than antibiotic therapy. The classical presentation of TSS is not often seen in patients with TSS complicating orthopaedic surgery. Wounds rarely have any signs of infection. This presentation may be even more difficult to identify due to the occasionally long latency period between surgery and the development of TSS. It appears that external fixators may be left in place if there are no signs of infection. This requires further study.