Proximal humerus deformity in a four-limb amputee following
Published in BMJ, the authors 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 the patient with inhibition of activities of daily living, requiring corrective osteotomy to help improve the range of motion of the shoulder.

The authors describe in detail the management of the 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.

Learning points
• Patients with amputations following meningococcal septicaemia should be referred directly to the paediatric orthopaedic service for monitoring of growth deformities until skeletal maturity.

• Parents of children with meningococcal septicaemia should be advised to monitor for deformities and advised to seek general practitioner referral to the paediatric orthopaedic service.

• A complete clinical and radiological examination should be performed to establish the growth plates involved.

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