Necrotising fasciitis following a supracondylar fracture and an open radius fracture in a child

  • Greg B Firth University of the Witwatersrand
  • C Oetzmann von Sochaczewski Chris Hani Baragwanath Academic Hospital
  • Y Ramguthy University of the Witwatersrand
  • A Khalfallah University of the Witwatersrand
Keywords necrotising fasciitis, open radius fracture, child, shoulder disarticulation

Abstract

Background: Necrotising fasciitis is a rare, rapidly progressing soft-tissue infection with a high mortality rate. Historically, necrotising fasciitis has been associated with penetrating injuries, and more recently with immunocompromise and severe comorbidities. This case report highlights the association of necrotising fasciitis in a child with an open distal radius fracture and a supracondylar fracture. 


Method and results (case report): A 10-year-old boy was admitted 24 hours after falling from a tree with a Gustilo and Anderson grade II distal radius fracture and a Gartland grade III supracondylar humerus fracture. The wound was debrided and the fractures reduced and stabilised with Kirschner wires. Within 48 hours of admission he developed a necrotising fasciitis that extended onto the chest and eventually resulted in a shoulder disarticulation. The tissue defects were covered with flaps and skin grafts and the patient was discharged home.


Conclusions: This case highlights the importance of having an early and high index of suspicion for necrotising fasciitis in a child with an open contaminated fracture and delay to both antibacterial chemotherapy and surgical debridement. Tissue trauma due to open fractures may obscure the early skin signs of necrotising fasciitis as well as laboratory risk factors. In the South African context, urgent administration of cephazolin and surgical exploration must be done to prevent the devastating complication of necrotising fasciitis.


Level of evidence: Level 5

Author Biographies

Greg B Firth, University of the Witwatersrand

MBBCh, FCS(Orth)SA, MMed(Orth)

Orthopaedic Surgeon

Department of Orthopaedic Surgery

Chris Hani Baragwanath Academic Hospital

University of the Witwatersrand

C Oetzmann von Sochaczewski, Chris Hani Baragwanath Academic Hospital

MD

Department of Paediatric Surgery

University of the Witwatersrand

Chris Hani Baragwanath Academic Hospital

Y Ramguthy, University of the Witwatersrand

MBChB, FCS(Orth)

Department of Orthopaedic Surgery

University of the Witwatersrand

Chris Hani Baragwanath Academic Hospital

A Khalfallah, University of the Witwatersrand

MD

Department of Orthopaedic Surgery

University of the Witwatersrand

Chris Hani Baragwanath Academic Hospital

Published
2018-05-22
How to Cite
FIRTH, Greg B et al. Necrotising fasciitis following a supracondylar fracture and an open radius fracture in a child. South African Orthopaedic Journal, [S.l.], p. 49-53, may 2018. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/217>. Date accessed: 23 oct. 2018.
Section
Paediatrics

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