JBJS Case Connections—The Clinical Challenges of Necrotizing Fasciitis

Despite the relative rarity of necrotizing fasciitis (NF), orthopaedists can expect to see at least 1 case of NF in their career. This month’s “Case Connections” springboards from a recent case report about necrotizing fasciitis in which the infectious source was highly unusual, followed by three additional case reports related to NF from the JBJS Case Connector archives

• In the June 8, 2016, edition ofJBJS Case Connector, Connor et al. reported on the case of a 70-year-old man who developed necrotizing fasciitis of the thigh and calf through a colon perforation caused by sigmoid diverticulitis.
• Zani and Babigian described a case of NF in the shoulder of a 53-year-old woman following acromioplasty and open rotator cuff repair.
• The bacteriumAeromonas hydrophila caused NF in a 58-year-old non-immunocompromised man, as described in a case report by Borger van der Burg et al.
• Cheng et al. described 3 fatal cases of necrotizing fasciitis caused by methicillin-resistant Staphylococcus aureus(MRSA).

Time and teamwork are of the essence in the management of necrotizing fasciitis. To hasten diagnosis, clinicians are advised to submit blood and tissue samples for pathological analysis as soon as possible. A multidisciplinary team that includes an infectious-disease specialist should be assembled in cases of suspected NF.