THE MANAGEMENT OF GROWTH ARRESTS IN CHILDREN FOLLOWING MENINGOCOCCAL SEPTICAEMIA

Abstract

Introduction and Aims: To determine the optimum management of growth arrests secondary to meningococcal septicaemia.

Method: A retrospective study of 28 children treated in children’s hospitals in the UK for long bone deformities caused by growth plate arrests secondary to meningococcal septicaemia.

Results: 28 children (age range four to eight years) with growth arrests of the long bones following meningococcal septicaemia were treated for their bony deformities (a limb length discrepancy or a progressive angular deformity of the upper or lower limb) using the Ilizarov technique. Resection of bony blocks was ineffective in preventing progressive deformities. Limb length discrepancies were treated satisfactorily with equalisation of limb lengths. Angular deformities required ablation of the remaining part of the affected growth plate in order to prevent recurrence. Distal tibial deformities were treated satisfactorily with a transepiphyseal osteotomy. In the upper limb lengthening of either the radius or ulna restored alignment to the wrist. One patient with a growth arrest affecting a tibial amputation stump underwent satisfactory stump realignment and lengthening. Limb lengthening will need to be repeated in younger children, as the deformity will recur with growth until skeletal maturity.

Conclusion: The Ilizarov technique enables satisfactory treatment of growth deformities secondary to meningococcal septicaemia. With peripheral growth plate arrests causing an angular deformity the remaining open growth plate needs to be ablated to prevent recurrence of the angular deformity. Any recurrence will then be a shortening only, which can be treated by further lengthening if required.