TOXIC SHOCK SYNDROME AS A COMPLICATION OF ORTHOPEDIC-SURGERY

Toxic shock syndrome (TSS) was initially described by Todd et al. in 1 978. TSS as a complication of orthopaedic surgery was reported in 1984 . There have been previously a total of nine cases of TSS reported in orthopaedic patients. These patients presented at an average of 13 day s postoperatively compared to 2 days for general surgical patients. Pa tients with external fixators, however, presented an average of 25 day s postoperatively. Menstrual TSS and nonmenstrual TSS present similarl y; however, the fatality rate is reported as 10 and 50%, respectively. There was a 27% case fatality rate in orthopaedic patients. Because T SS is not a septicemia but a toxemia, the treatment depends on aggress ive hemodynamic stabilization rather than antibiotic therapy. The clas sical presentation of TSS is not often seen in patients with TSS compl icating orthopaedic surgery. Wounds rarely have any signs of infection . This presentation may be even more difficult to identify due to the occasionally long latency period between surgery and the development o f TSS. It appears that external fixators may be left in place if there are no signs of infection. This requires further study.