Long-term results of bacterial septic arthritis of the wrist

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Abstract

Septic arthritis of the wrist is a serious condition, yet little is known about its long-term outcome. A retrospective analysis of 22 patients treated for bacterial septic arthritis of the wrist was conducted with subsequent follow-up of 18 patients with a median period of 44 months to assess functional results via DASH-Score and clinical examination.

Arthrotomy was used to treat all patients; in 19 patients, multiple operations were needed to cure the infection. Follow-up revealed a mean DASH-score of 34 (SD 22) and a significant correlation with needed surgical radicality and number of needed operations. The range of motion of the wrist and grip strength of the affected side was 49% (SD 20%) and 70% (SD 28%) of the contralateral side, respectively. In conclusion, septic arthritis of the wrist leads to long-term functional restrictions with a strong correlation with the stage of the disease. Hence, early diagnosis and treatment are paramount.

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)

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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.

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