versión On-line ISSN 2309-8309
SA orthop. j. vol.8 no.4 Pretoria ene. 2009
MN RasoolI; J Pryce-LewisII; R SmitII
IFCS(Orth); Consultant Orthopaedic Surgeon. Department of Orthopaedics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban
IIMBChB; Registrar. Department of Orthopaedics, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban
Ischaemia of the foot in infants is a cause for concern leading to gangrene, amputation and medicolegal inquiry. The causes of gangrene are usually complicated and multifactorial.1 The gangrene usually develops following a severe bacterial or viral infection. Septicaemia is usually accompanied by dehydration, shock and severe metabolic derangements. Mechanical causes include invasive vascular procedures and venipuncture especially in newborns.
The gangrenous change may imply surgical error especially when the infections occur following surgery or plaster cast immobilisation.
Children who survive these infections are at a higher risk for complex orthopaedic problems later with growth. Involvement of the physeal circulation due especially to bacterial septicaemia may take several years to manifest resulting in longitudinal and transverse growth problems.2 Ischaemic insults to the developing skeleton result in gangrene, skin necrosis and irregularities of epiphysis, metaphysis and physis with premature physeal closure. This may require skin grafting (and later release of contractures), amputation (and later revision of stump) and orthopaedic procedures to address deformity and leg length discrepancy.
It is important for the orthopaedic surgeon to become involved early in the treatment team to decide on fasciotomy, amputation level, prosthetic fitting and anticipated long-term growth problems.
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Mr MN Rasool
Department of Orthopaedics
Nelson R Mandela School of Medicine
University of KwaZulu-Natal
Private Bag 7
Tel: (031) 260-4297; Fax: (031) 260-4518
This article is the sole work of the authors. No benefits of any form are to be received from a commercial party related directly or indirectly to the subject of this article.