Journal of Plastic, Reconstructive & Aesthetic Surgery
Long-term results of bacterial septic arthritis of the wrist☆
Introduction
Septic arthritis of the wrist is a surgical emergency in hand surgery. The etiology of this infectious condition ranges from septic bacteremia to posttraumatic and, importantly, iatrogenic after wrist surgery or intervention. Diagnosis can be challenging and involves differential diagnoses of crystal arthropathy, rheumatoid arthritis, or activated osteoarthritis.
Depending on the state and progress of the infection, radical surgical debridement may require resectioning joint structures, which can ultimately lead to loss of function.
The literature on the long-term results of treatment is scarce. Therefore, this study aimed to perform a long-term follow-up of treated patients with septic arthritis of the wrist to assess the functional outcome and disability. We hypothesised long-term disability depending on the stage of infection. Additionally, variables regarding epidemiology, diagnosis, and treatment of the condition were analysed.
Section snippets
Patients and methods
Twenty-two patients, treated in our institution for bacterial septic arthritis of the wrist from 2008 to 2015, were identified based on their medical records. The inclusion criterion was septic arthritis of the wrist with positive bacterial culture from the microbial specimen; the only exclusion criterion was anyone under the age of 18. Figure 1 shows a flow diagram of the patients included in the study.
Data regarding patient characteristics, diagnostic variables, and treatment were collected
Retrospective analysis
The age of patients upon diagnosis ranged from 29 to 84 with a median of 60.5 years. 18 of the patients were male, representing the vast majority of the study population.
Three patients were immunocompromised due to therapy or an underlying disease; only one patient had a preexisting condition of gout.
Findings upon presentation included wrist pain (21 patients), wrist swelling (21 patients), erythema (16 patients), and hyperthermia of the wrist (12 patients). A typical presentation of a patient
Discussion
It has been shown that, in patients with atraumatic, painful, swollen or erythematous wrist, septic arthritis is the underlying cause in only 5% of patients.1
While this may be true in the general collective, recent events like trauma, surgery of the wrist or intervention, or general risk factors like a compromised immune system should alert the surgeon towards septic arthritis. As this study only included patients with assured bacterial arthritis with positive microbial culture, no statement
Conflict of interest
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Financial support
The authors received no financial support for the research, authorship, and/or publication of this article.
Ethics
The study was conducted according to the Declaration of Helsinki, approval by the ethics committee of the Ruhr-University in Bochum was given (approval number 16-5830-BR). The Strobe guidelines for cross-sectional studies were followed.
References (16)
- et al.
Epidemiology of suspected wrist joint infection versus inflammation
J Hand Surg Am
(2011) - et al.
Does the presence of crystal arthritis rule out septic arthritis?
J Emerg Med
(2007) - et al.
How sensitive is the synovial fluid white blood cell count in diagnosing septic arthritis?
Am J Emerg Med
(2007) - et al.
Contribution of arthroscopy in case of septic appearance arthritis of the wrist: a nine cases series
Chir Main
(2013) - et al.
Arthroscopic management of septic arthritis of the wrist
Hand Clin
(2011) - et al.
Laboratory tests in adults with monoarticular arthritis: can they rule out a septic joint?
Acad Emerg Med
(2004) - et al.
Indicators for detection of septic arthritis in the acutely swollen joint cohort of those without joint prostheses
Orthopedics
(2014) - et al.
Septic arthritis of the wrist: incidence, risk factors, and predictors of infection
Orthopedics
(2017)
Cited by (0)
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Part of this article has been presented at the following meeting:
1. The 58th annual meeting of the German Society for Hand Surgery, October 12-14th 2017 in Munich, Germany.