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The orthopaedic implications of peripheral limb ischaemia in infants and children
M J Farrar1, G C Bennet, N I Wilson
1Orthopaedic Department, The Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
Insights
Peripheral limb ischemia in children is rare, often linked to severe illness or infection. Outcomes include amputations and long-term orthopedic issues like limb-length discrepancy.
Area of Science:
- Pediatric vascular surgery
- Neonatal and pediatric critical care
Background:
- Peripheral limb ischemia is an uncommon condition in pediatric patients.
- The study focuses on a 15-year experience at a single pediatric center.
Purpose of the Study:
- To analyze the factors contributing to peripheral limb ischemia in infants and children.
- To evaluate the outcomes of initial treatments and subsequent orthopedic complications.
Main Methods:
- Retrospective analysis of 12 pediatric cases of peripheral limb ischemia.
- Review of clinical data, treatment strategies, and long-term follow-up for orthopedic issues.
Main Results:
- Most cases (9 neonates, 3 older children) were associated with critical illness or infection.
- Amputations were necessary in several cases (legs, arm, feet, toes), with two requiring bilateral leg amputations.
- Five children experienced post-ischemic orthopedic deformities, including limb-length discrepancy and angular deformities, with two needing corrective surgery.
Conclusions:
- Peripheral limb ischemia in children often presents in the context of severe systemic illness.
- Management requires careful consideration of amputation timing and delayed closure.
- Long-term orthopedic surveillance and potential corrective surgery are crucial for affected children.
Abstract:
Peripheral limb ischaemia is rare in children. We have treated only 12 infants and children with this condition in the past 15 years at the Royal Hospital for Sick Children in Glasgow. There were nine neonates and three older children. Most were suffering from life-threatening illnesses or severe infection. Two were born with ischaemic arms with no apparent cause. We have analysed the factors leading to ischaemia, the outcome of the initial treatment and the later orthopaedic problems. Two required amputation of both legs, one of an arm, two of feet and one of toes. Two had skin grafts. All surgery was performed after demarcation was well established and delayed closure was used after amputation. Five children developed limb-length discrepancy or an angular deformity. To date two have required additional corrective surgery.