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Case Reports
. 2018 Oct 25:2018:bcr2018226040.
doi: 10.1136/bcr-2018-226040.

Proximal humerus deformity, in a four-limb amputee following meningococcal septicaemia

Adeel Ikram  1 , Kriti Singhania  1 , Suhayl Tafazal  1 , Amol Tambe  1
Affiliations
Case Reports

Proximal humerus deformity, in a four-limb amputee following meningococcal septicaemia

Adeel Ikram et al. BMJ Case Rep. .

Abstract

We present a challenging case of proximal humerus varus deformity in a four-limb amputee, caused by growth arrest from meningococcal septicaemia. The deformity resulted in a loss of function for our patient with inhibition of activities of daily living, requiring corrective osteotomy to help improve the range of motion of the shoulder. We describe in detail the management of our patient, highlight the importance of the orthopaedic manifestations of meningococcal septicaemia, and demonstrate the importance of monitoring potential deformities from growth arrest in these patients.

Keywords: bone and joint infections; orthopaedic and trauma surgery; orthopaedics; paediatrics.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Reduced shoulder abduction.
Figure 2
Figure 2
Reduced shoulder forward flexion.
Figure 3
Figure 3
Anteroposterior radiograph of the left shoulder proximal humerus varus deformity, with prominent tuberosity.
Figure 4
Figure 4
CT scan demonstrating fusion of the proximal humerus physis and varus deformity.
Figure 5
Figure 5
Examination under anaesthesia, demonstrating mechanical impingement of tuberosity against acromion.
Figure 6
Figure 6
Planning the proximal humerus osteotomy according to the technique described by Gill and Waters.
Figure 7
Figure 7
Use of Kirschner wires to guide osteotomy.
Figure 8
Figure 8
15 mm wedge of bone removed from proximal humerus metaphysis.
Figure 9
Figure 9
Intraoperative fluoroscopy demonstrating fixation using paediatric hip locking plate.
Figure 10
Figure 10
Post-operative shoulder abduction.
Figure 11
Figure 11
Post-operative shoulder forward flexion.
See this image and copyright information in PMC

References

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    1. Edwards TA, Bowen L, Bintcliffe F, et al. The Orthopaedic Consequences of Childhood Meningococcal Septicaemia. J Maningitis 2016;1:109.
    1. Gill TJ, Waters P. Valgus osteotomy of the humeral neck: a technique for the treatment of humerus varus. J Shoulder Elbow Surg 1997;6:306–10. 10.1016/S1058-2746(97)90021-5 - DOI - PubMed
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