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A gangrenous limb is a dead limb resulting from compromise of the vascular supply to the limb. The gangrenous limb is a source of infection which can lead to septicaemia with eventual mortality of the patient, hence it is an orthopaedic emergency. Limb gangrene is common in orthopaedic practice but rare in neonatal age group. These are two cases of...
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Citations
... The first one is due to compression, which is because of intrauterine position of the fetus or entanglement of the umbilical cord around the limb. In such cases, ischemic signs can appear soon after birth [7,8] and frequently results in auto amputation of the limb. The next cause is due to vasospasm, which may occur especially during a traumatic delivery. ...
Acute limb ischemia in the neonatal period is a rarely reported complication of prematurity and needs a high index of suspicion for early diagnosis and a multidisciplinary approach for its management. Here, we present a case of a preterm baby that developed unilateral upper limb ischemia in the neonatal period and discussed the problems faced in the management of such cases. A 24‐day‐old male baby was referred to the orthopedics department because of bluish‐black discoloration of the right hand and forearm and no active movement in the wrist and hand. The baby was preterm, delivered at 29 weeks of gestation lower‐segment cesarean section with a birth weight of 900 g to a healthy mother with no preexisting illness. Although the line of demarcation was just below the elbow joint and conventional wisdom would dictate us to go for a transhumeral amputation, we opted for a below elbow amputation in a bid to save the elbow joint as we could have revised the amputation at a later date if needed. Neonatal acute limb ischemia has been rarely reported and needs a high index of suspicion. Preterm and low birth weight babies are more prone to it. Treatment of such patients depends on the cause of gangrene. Amputation at such young age is psychologically disturbing for the parents. However, it is usually associated with good functional outcomes as the child has not yet learned the use of a limb or developed cortical plasticity in the brain. All attempts should be made to preserve as much joint and physis as possible to have a functional joint with better prosthetic fitting.
Keywords: Amputation, limb ischemia, neonatal gangrene, prematurity
... Sepsis often complicates the gangrene and could be a contributory factor to mortality especially if the patients present late. 9,11,25 The only mortality in the present study had septicaemia as well as generalized tetanus. Tetanus complicating lower extremity fractures and limb gangrene managed by traditional bone setters had been reported by others. ...
... 17 Traditional bone setters' gangrene is a major contributor to indications for amputations in developing countries and especially in children. 9,[22][23][24][25][26]28 The resulting loss of limb is unwarranted and is both an avoidable and preventable disaster. 9,12,[22][23][24][25]29 Limb loss in the lower extremity can result in significant morbidity, disability and profound economic, social and psychological effects on the patient and family especially in developing countries where prosthetic services are poor. ...
... 9,[22][23][24][25][26]28 The resulting loss of limb is unwarranted and is both an avoidable and preventable disaster. 9,12,[22][23][24][25]29 Limb loss in the lower extremity can result in significant morbidity, disability and profound economic, social and psychological effects on the patient and family especially in developing countries where prosthetic services are poor. [30][31][32] This is particularly significant for children who would have to cope with these challenges for the rest of their lives. ...
Background: Worldwide, lower extremity gangrene in children is rare. In orthopaedic practice in developing countries, a frequent cause of extremity gangrene is the practice of traditional bone setting. Aim of the study was to document lower extremity gangrene in children resulting from the care of traditional bone setters’ as seen in a tertiary health institution.Methods: A prospective study of children presenting with lower extremity gangrene from the care of traditional bone setters at the University of Port Harcourt Teaching Hospital from January 2006 to December 2018. Data obtained included the patients socio-demographics and relevant information related to the diagnosis. Data was analysed with SPSS version 20.Results: Eighteen children with lower extremity gangrene were seen. Their ages ranged from 10 days to 132 months. There was a female preponderance. Their parents mostly had primary and secondary levels of education and majority were married. The most common diagnosis was tibiofibular fractures followed by congenital clubfoot. Trauma-related injuries were mostly from falls. Duration before presentation ranged from 7 to 28 days. Majority had massage, splinting and bandaging from the bone setter. Most common associated complication at presentation was sepsis. All had provisional amputation. Most common amputation was below knee. Most had stump refashioning within 15 days. One had split skin grafting. There was one mortality. Duration of hospital stay ranged from 3 to 65 days.Conclusions: Children at any age can develop lower extremity gangrene from traditional bone setters’ care. This is an avoidable and preventable sequelae of care. Parental health education is necessary to discourage their patronizing traditional bone setters.
