Septicaemia resulting from meningococcal infection is a devastating illness affecting children. Those who survive can develop late orthopaedic sequelae from growth plate arrests, with resultant complex deformities. Our aim in this study was to review the case histories of a series of patients with late orthopaedic sequelae, all treated by the senior author (CFB). We also describe a treatment strategy to address the multiple deformities that may occur in these patients.

Between 1997 and 2009, ten patients (seven girls and three boys) were treated for late orthopaedic sequelae following meningococcal septicaemia. All had involvement of the lower limbs, and one also had involvement of the upper limbs. Each patient had a median of three operations (one to nine). Methods of treatment included a combination of angular deformity correction, limb lengthening and epiphysiodesis. All patients were skeletally mature at the final follow-up. One patient with bilateral below-knee amputations had satisfactory correction of her right amputation stump deformity, and has complete ablation of both her proximal tibial growth plates. In eight patients length discrepancy in the lower limb was corrected to within 1 cm, with normalisation of the mechanical axis of the lower limb.

Meningococcal septicaemia can lead to late orthopaedic sequelae due to growth plate arrests. Central growth plate arrests lead to limb-length discrepancy and the need for lengthening procedures, and peripheral growth plate arrests lead to angular deformities requiring corrective osteotomies and ablation of the damaged physis. In addition, limb amputations may be necessary and there may be altered growth of the stump requiring further surgery. Long-term follow-up of these patients is essential to recognise and treat any recurrence of deformity.

The Taylor-Spatial fame is increasingly being used for complex corrective surgery. The frame and SPATIAL FRAME.COM internet software are powerful surgical tools. There are few paediatric cases in the literature. We present the results from The Royal Orthopaedic Hospital, Birmingham.

All consecutive patients having treatment with Taylor-Spatial Frames over a 3 year period were enrolled in the trial. All patients under 18 were included. The frames were applied to treat angular deformities and leg length discrepancies. The conditions included Blounts disease, post meningio-coccal septicemia, femoral growth arrest, fibular hemimelia and Olliers disease.

Seventeen frames were applied to thirteen patients. The average age was 9.3 (2–17). All radiographs were reviewed and the deformities recorded to provide reference for the correction. We recorded angulation and translation in three planes; anteroposterior, lateral and axial. This data was input to SPATIAL-FRAME.COM, the strut length changes were calculated and printed out. Osteotomies were performed depending on the pathology if necessary. The patients did not start the correction protocol until 5 days post-operatively. The average correction time was 28 days (5–80) All frames were left in situ until 3 corticies were visible in the regenerate. We recorded patient satisfaction, deformity correction, infection and bony union rates.

All frames provided full correction to within normal anatomical ranges, there were no cases of deep infection. 3 Superficial pin site infections were recorded and swabs confirmed staph aureus. Patients were very satisfied overall. One patient with bilateral Blounts disease had a gradual reoccurrence of the deformity after full correction initially. 1 case required bone grafting to improve regenerate production. Interestingly he had been taking anti-inflammatories. All cases achieved bony union.

Between 1990 and 2001, 24 children aged between 15 months and 11 years presented with late orthopaedic sequelae after meningococcal septicaemia. The median time to presentation was 32 months (12 to 119) after the acute phase of the disease. The reasons for referral included angular deformity, limb-length discrepancy, joint contracture and problems with prosthetic fitting. Angular deformity with or without limb-length discrepancy was the most common presentation. Partial growth arrest was the cause of the angular deformity. Multiple growth-plate involvement occurred in 14 children. The lower limbs were affected much more often than the upper. Twenty-three children underwent operations for realignment of the mechanical axis and limb-length equalisation. In 15 patients with angular deformity around the knee the deformity recurred. As a result we recommend performing a realignment procedure with epiphysiodesis of the remaining growth plate when correcting angular deformities.

We present the results of the management of 17 relapsed club feet in 12 children using the Ilizarov method with gradual distraction and realignment of the joint. Review at a mean of three years after surgery showed maintenance of correction with excellent or good results in 13 feet. Five mobile feet which had been treated by a split transfer of the tibialis anterior tendon two weeks after removal of the frame had an excellent result.