Necrotising fasciitis following closed femoral diaphyseal fracture in a child

Abstract

Necrotising fasciitis is a rare infectious process that progresses rapidly especially in fascial and subcutaneous tissues. A 13-year-old boy with cerebral palsy developed closed femoral diaphyseal fracture due to a fall. He was hospitalized for surgery. On the seventh day of admission, he developed many bullous lesions and dark isolated skin lesions in the anterior and lateral thigh, accompanied by fever, sensitivity in the thigh, edema, disturbed respiration, and acute abdomen. With an initial diagnosis of necrotising fasciitis, he underwent surgical exploration of the abdomen, which showed only serous collections and a distended abdomen. The lesion area in the thigh was incised and extensive fascial necrosis and occasional muscular necrosis were observed in the quadriceps fascia. A wide radical fasciectomy, debridement and irrigation were performed. Staphylococcus aureus was isolated from the surgical specimens. After the patient resumed a stable condition, the diaphyseal fracture was fixed with an external fixator. Four months postoperatively, pin track infection and loosening were detected, the fixator was removed and intramedullary fixation was performed with two titanium elastic nails, after which union was achieved.