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Jetanalin P, Raksadawan Y, Inboriboon PC. Orthopedic Articular and Periarticular Joint Infections. Emerg Med Clin North Am 2024; 42:249-265. [PMID: 38641390 DOI: 10.1016/j.emc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Acute nontraumatic joint pain has an extensive differential. Emergency physicians must be adept at identifying limb and potentially life-threatening infection. Chief among these is septic arthritis. In addition to knowing how these joint infections typically present, clinicians need to be aware of host and pathogen factors that can lead to more insidious presentations and how these factors impact the interpretation of diagnostic tests.
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Affiliation(s)
- Pim Jetanalin
- Department Medicine, Division of Rheumatology, University of Illinois at College of Medicine, 818 South Wolcott Avenue, 6th Floor, MC 733, Chicago, IL 60612, USA.
| | - Yanint Raksadawan
- Department of Medicine, Weiss Memorial Hospital, Medical Education, 4646 N. Marine Drive, Chicago, IL 60640, USA
| | - Pholaphat Charles Inboriboon
- Department of Emergency Medicine, University of Illinois at College of Medicine, 808 South Wood Street MC 724, Chicago, IL, USA
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2
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El Zein S, Berbari E, LeMahieu AM, Jagtiani A, Sendi P, Virk A, Morrey ME, Tande A. Optimal antibiotics duration following surgical management of septic olecranon bursitis: a 12-year retrospective analysis. J Bone Jt Infect 2024; 9:107-115. [PMID: 38779581 PMCID: PMC11110802 DOI: 10.5194/jbji-9-107-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/26/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction: The absence of a standardized postoperative antibiotic treatment approach for patients with surgically treated septic bursitis results in disparate practices. Methods: We retrospectively reviewed charts of adult patients with surgically treated septic olecranon bursitis at Mayo Clinic sites between 1 January 2000 and 20 August 2022, focusing on their clinical presentation, diagnostics, management, postoperative antibiotic use, and outcomes. Results: A total of 91 surgically treated patients were identified during the study period. Staphylococcus aureus was the most common pathogen (64 %). Following surgery, 92 % (84 of 91 patients) received systemic antibiotics. Excluding initial presentations of bacteremia or osteomyelitis (n = 5 ), the median duration of postoperative antibiotics was 21 d (interquartile range, IQR: 14-29). Postoperative complications were observed in 23 % (21 of 91) of patients, while cure was achieved in 87 % (79 of 91). Active smokers had 4.53 times greater odds of clinical failure compared with nonsmokers (95 % confidence interval, 95 % CI: 1.04-20.50; p = 0.026 ). The highest odds of clinical failure were noted in cases without postoperative antibiotic administration (odds ratio, OR: 7.4). Conversely, each additional day of antibiotic treatment, up to 21 d, was associated with a progressive decrease in the odds of clinical failure (OR: 1 at 21 d). Conclusion: The optimal duration of antibiotics postoperatively in this study was 21 d, which was associated with a 7.4-fold reduction in the odds clinical failure compared with cases without postoperative antibiotics. Further validation through a randomized controlled trial is needed.
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Affiliation(s)
- Said El Zein
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elie F. Berbari
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Anil Jagtiani
- Department of Infectious Diseases, Kaiser Permanente Southern California, Fontana, CA, USA
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Abinash Virk
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mark E. Morrey
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Aaron J. Tande
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Pohl NB, Brush PL, Toci GR, Heinle JT, Thomas A, Hornstein J, Aita D, Beredjiklian P, Katt B, Fletcher D. Clinical Outcomes Following Open Olecranon Bursa Excision for Septic and Aseptic Olecranon Bursitis: An Observational Study. Cureus 2023; 15:e43696. [PMID: 37724223 PMCID: PMC10505354 DOI: 10.7759/cureus.43696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Background and objective Olecranon bursitis (aseptic or septic) is caused by inflammation in the bursal tissue. While it is typically managed with conservative measures, refractory cases may indicate surgical intervention. There is currently limited research about outcomes following bursal excision for both septic and aseptic etiologies. In light of this, the purpose of this study was to determine if patients experienced improvement following surgical olecranon bursa excision and to compare outcomes between septic and aseptic forms. Materials and methods A retrospective review was performed involving patients who underwent olecranon bursa excision from 2014 to 2021. Demographic data, patient characteristics, surgical data, and outcome-related data were collected from the medical records. Patients were classified into subgroups based on the type of olecranon bursitis (septic or aseptic). Preoperative and one-year postoperative 12-item short-form survey (SF-12) results and range of motion (ROM) outcomes were evaluated for the entire cohort as well as the subgroups. Results We included 61 patients in our study and found significant improvement in the Physical Component Scale 12 (PCS-12) score for all patients (42.0 vs. 45.5, p=0.010) following surgery. However, based on subgroup analysis, the aseptic group improved in PCS-12 following surgery (41.5 vs. 46.8, p<0.001), but the septic group did not (43.6 vs. 40.5, p=0.277). No improvements were found in the Mental Component Scale 12 (MCS-12) scores following surgery in either group. Eighteen of the 61 patients experienced postoperative complications (29.5%), but only 6.5% required a second surgical procedure. Specifically, 14 of the 18 complications occurred in the aseptic group while two septic and two aseptic patients required additional surgeries. Elbow ROM did not change significantly after surgery but more patients were found to have full ROM postoperatively (83.0% to 91.8%, p=0.228). Conclusion Our findings suggest that patients with refractory olecranon bursitis, particularly if aseptic, tend to gain significant physical health benefits from open bursectomy.
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Affiliation(s)
- Nicholas B Pohl
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Parker L Brush
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Gregory R Toci
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Jeremy T Heinle
- Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA
| | - Anna Thomas
- Orthopaedic Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Joshua Hornstein
- Division of Sports Medicine, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Daren Aita
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Pedro Beredjiklian
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
| | - Brian Katt
- Division of Hand Surgery, Hackensack Meridian Ocean Medical Center, Brick Township, USA
| | - Daniel Fletcher
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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4
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Brown OS, Smith TO, Parsons T, Benjamin M, Hing CB. Management of septic and aseptic prepatellar bursitis: a systematic review. Arch Orthop Trauma Surg 2022; 142:2445-2457. [PMID: 33721054 DOI: 10.1007/s00402-021-03853-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 03/01/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite contributing to significant morbidity in working-age adults, there is no consensus on the optimal treatment for prepatellar bursitis. Much of the existing literature combines prepatellar and olecranon bursitis. This systematic review aims to determine the optimal management of prepatellar bursitis. STUDY DESIGN AND METHODS A primary search of electronic published and unpublished literature databases from inception to November 2019 was completed. Articles over 25 years old, case reports with less than four patients, paediatric studies, and non-English language papers were excluded. Our primary outcome was recurrence after 1 year. Comparisons included endoscopic vs open bursectomy, duration of antibiotics. Methodological quality was assessed using the Institute of Health Economics and Revised Cochrane Risk of Bias scoring systems. Meta-analyses were conducted where appropriate. RESULTS In total 10 studies were included (N = 702). Endoscopic and open bursectomy showed no difference in recurrence after 1 year (OR 0.41, 95% CI 0.05-3.53, p = 0.67), and surgical complications (OR 1.44, 95% CI 0.34-6.08, p = 0.44). 80% endoscopically-treated patients were pain free after 1 year. Patients treated with antibiotics for less than 8 days were not significantly more prone to recurrence (2/17 vs 10/114, OR 0.66, 95% CI 0.13-3.29, p = 0.64) compared to 8 days plus at minimum 1 year post injury. CONCLUSIONS Our study represents the largest cohort of patients evaluating management strategies for prepatellar bursitis, and includes data not previously published. Endoscopic bursectomy is non-inferior to open bursectomy, enabling a shorter hospital stay. It also offers a relatively low risk of post-operative pain. Endoscopic bursectomy is a viable option to treat both septic and aseptic prepatellar bursitis. Our small cohort suggests recurrence and hospital stay are not improved with antibiotic treatment exceeding 7 days for septic prepatellar bursitis.
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Affiliation(s)
- Oliver S Brown
- St George's University Hospitals NHS Foundation Trust, London, UK. .,Trauma and Orthopaedic Department, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK.
| | - T O Smith
- Oxford University Hospitals, Oxford, UK
| | - T Parsons
- Epsom and St Helier Hospitals, London, UK
| | - M Benjamin
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - C B Hing
- St George's University Hospitals NHS Foundation Trust, London, UK
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5
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Charret L, Bart G, Hoppe E, Dernis E, Cormier G, Boutoille D, Le Goff B, Darrieutort-Laffite C. Clinical characteristics and management of olecranon and prepatellar septic bursitis in a multicentre study. J Antimicrob Chemother 2021; 76:3029-3032. [PMID: 34293150 DOI: 10.1093/jac/dkab265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND No current guidelines are available for managing septic bursitis (SB). OBJECTIVES To describe the clinical characteristics and management of olecranon and prepatellar SB in five French tertiary care centres. METHODS This is a retrospective observational multicentre study. SB was diagnosed on the basis of positive cultures of bursal aspirate. In the absence of positive bursal fluid, the diagnosis came from typical clinical presentation, exclusion of other causes of bursitis and favourable response to antibiotic therapy. RESULTS We included 272 patients (median age of 53 years, 85.3% male and 22.8% with at least one comorbidity). A microorganism was identified in 184 patients (67.6%), from bursal fluids in all but 4. We identified staphylococci in 135 samples (73.4%), streptococci in 35 (19%) and 10 (5.5%) were polymicrobial, while 43/223 bursal samples remained sterile (19.3%). Forty-nine patients (18%) were managed without bursal fluid analysis. Antibiotic treatment was initially administered IV in 41% and this route was preferred in case of fever (P = 0.003) or extensive cellulitis (P = 0.002). Seventy-one (26%) patients were treated surgically. A low failure rate was observed (n = 16/272, 5.9%) and failures were more frequent when the antibiotic therapy lasted <14 days (P = 0.02) in both surgically and medically treated patients. CONCLUSIONS Despite variable treatments, SB resolved in the majority of cases even when the treatment was exclusively medical. The success rate was equivalent in the non-surgical and the surgical management groups. However, a treatment duration of <14 days may require special attention in both groups.
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Affiliation(s)
- Laurie Charret
- Rheumatology Department, CHU Nantes, Nantes, France.,Rheumatology Department, CHD Vendée, La Roche-Sur-Yon, France
| | - Géraldine Bart
- Rheumatology Department, CHU Rennes, Rennes, France.,Centre de référence en infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), CHU de Rennes, 35043, Rennes cedex, France
| | | | | | | | - David Boutoille
- Centre de référence en infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), CHU de Rennes, 35043, Rennes cedex, France.,Department of Infectious Diseases, CHU Nantes, Nantes, France.,Centre d'Investigation Clinique, Unité d'Investigation Clinique 1413 INSERM, CHU Nantes, Nantes, France
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Lormeau C, Cormier G, Sigaux J, Arvieux C, Semerano L. Management of septic bursitis. Joint Bone Spine 2018; 86:583-588. [PMID: 31615686 DOI: 10.1016/j.jbspin.2018.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/21/2022]
Abstract
Superficial septic bursitis is common, although accurate incidence data are lacking. The olecranon and prepatellar bursae are the sites most often affected. Whereas the clinical diagnosis of superficial bursitis is readily made, differentiating aseptic from septic bursitis usually requires examination of aspirated bursal fluid. Ultrasonography is useful both for assisting in the diagnosis and for guiding the aspiration. Staphylococcus aureus is responsible for 80% of cases of superficial septic bursitis. Deep septic bursitis is uncommon and often diagnosed late. The management of septic bursitis varies considerably across centers, notably regarding the use of surgery. Controlled trials are needed to establish standardized recommendations regarding antibiotic treatment protocols and the indications of surgery.
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Affiliation(s)
- Christian Lormeau
- Service de rhumatologie, centre hospitalier de Niort, 40, avenue Charles-de-Gaulle, 79021 Niort, France.
| | - Grégoire Cormier
- Service de rhumatologie, centre hospitalier départemental Vendée, boulevard Stéphane-Moreau, 85928 La Roche-sur-Yon, France
| | - Johanna Sigaux
- Inserm, UMR 1125, 1, rue de Chablis, 93017 Bobigny, France; Sorbonne Paris Cité, université Paris 13, 1, rue de Chablis, 93017 Bobigny, France; Service de rhumatologie, groupe hospitalier Avicenne-Jean-Verdier-René-Muret, Assistance publique-Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93017 Bobigny, France
| | - Cédric Arvieux
- Clinique des maladies infectieuses, CHU de Rennes Pontchaillou, rue Henri-Le-Guilloux, 35043 Rennes, France; Centre de référence en infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), CHU de Rennes, 35043 Rennes cedex, France
| | - Luca Semerano
- Inserm, UMR 1125, 1, rue de Chablis, 93017 Bobigny, France; Sorbonne Paris Cité, université Paris 13, 1, rue de Chablis, 93017 Bobigny, France; Service de rhumatologie, groupe hospitalier Avicenne-Jean-Verdier-René-Muret, Assistance publique-Hôpitaux de Paris (AP-HP), 125, rue de Stalingrad, 93017 Bobigny, France
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Uçkay I, von Dach E, Perez C, Agostinho A, Garnerin P, Lipsky BA, Hoffmeyer P, Pittet D. One- vs 2-Stage Bursectomy for Septic Olecranon and Prepatellar Bursitis: A Prospective Randomized Trial. Mayo Clin Proc 2017; 92:1061-1069. [PMID: 28602435 DOI: 10.1016/j.mayocp.2017.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/01/2017] [Accepted: 03/15/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the optimal surgical approach and costs for patients hospitalized with septic bursitis. PATIENTS AND METHODS From May 1, 2011, through December 24, 2014, hospitalized patients with septic bursitis at University of Geneva Hospitals were randomized (1:1) to receive 1- vs 2-stage bursectomy. All the patients received postsurgical oral antibiotic drug therapy for 7 days. RESULTS Of 164 enrolled patients, 130 had bursitis of the elbow and 34 of the patella. The surgical approach used was 1-stage in 79 patients and 2-stage in 85. Overall, there were 22 treatment failures: 8 of 79 patients (10%) in the 1-stage arm and 14 of 85 (16%) in the 2-stage arm (Pearson χ2 test; P=.23). Recurrent infection was caused by the same pathogen in 7 patients (4%) and by a different pathogen in 5 (3%). Outcomes were better in the 1- vs 2-stage arm for wound dehiscence for elbow bursitis (1 of 66 vs 9 of 64; Fisher exact test P=.03), median length of hospital stay (4.5 vs 6.0 days), nurses' workload (605 vs 1055 points), and total costs (Sw₣6881 vs Sw₣11,178; all P<.01). CONCLUSION For adults with moderate to severe septic bursitis requiring hospital admission, bursectomy with primary closure, together with antibiotic drug therapy for 7 days, was safe, effective, and resource saving. Using a 2-stage approach may be associated with a higher rate of wound dehiscence for olecranon bursitis than the 1-stage approach. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01406652.
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Affiliation(s)
- Ilker Uçkay
- Orthopaedic Surgery Service, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Service of Infectious Diseases, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Infection Control Program, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Elodie von Dach
- Infection Control Program, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Cédric Perez
- Orthopaedic Surgery Service, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Americo Agostinho
- Orthopaedic Surgery Service, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Infection Control Program, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Garnerin
- Service of Anesthesiology, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benjamin A Lipsky
- Service of Infectious Diseases, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Pierre Hoffmeyer
- Orthopaedic Surgery Service, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Didier Pittet
- Service of Infectious Diseases, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; Infection Control Program, Medico-Economic Control, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; WHO Collaboration Center on Patient Safety, Geneva, Switzerland
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Wyen H, Jakob V, Neudecker J, Tenckhoff S, Seidel D, Affüpper-Fink M, Knöll P, Neugebauer EAM. [Why nurses fly and surgeons rotate. The surgical study network CHIR-Net]. Chirurg 2014; 84:580-6. [PMID: 23619764 DOI: 10.1007/s00104-013-2500-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The German National Surgical Trial Network (CHIR-Net) which has been funded since 2006 by the Federal Ministry of Education and Research (BMBF, funding code 01GH1001A-01GH1001F, 01GH0702) is made up of eight regional surgical centers. The aim of the CHIR-Net is the design, implementation and publication of prospective, randomized, multicenter trials to support evidence-based medicine in surgery. Two main pillars of the CHIR-Net are the surgeon on rotation program and the flying study nurse program. With these two programs the surgical hospitals are supported in their trial working by educating competent investigators and the infrastructural support of flexible and mobile study nurses. METHODS The surgeon on rotation program and the concept of the flying study nurse are presented descriptively. Furthermore, this paper provides reports of experiences of a surgeon on rotation and a flying study nurse of the CHIR-Net. Additionally, the results of an on-line evaluation of the regional surgical hospitals (belonging to the regional surgical center of the universities Witten/Herdecke and Cologne) regarding the needs and requirements of the regional surgical hospitals are presented. RESULTS The surgeon on rotation program of the CHIR-Net offers investigators the possibility to acquire the basics of designing, developing and implementation of high quality clinical trials. In addition, their own study projects could be intensively driven forward. The flying study nurse program enables in particular non-university surgical hospitals to be supported competitively in performing their own study projects and participating in muliticenter clinical trials. The success of these two programs has been confirmed by the conducted evaluations and the presented field reports. CONCLUSION The CHIR-Net is able to develop a high quality study culture in Germany with its surgeon on rotation and flying study nurse program. In addition to the funding period by the BMBF, the continuance of the CHIR-Net should be a primary aim of further measures.
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Affiliation(s)
- H Wyen
- Institut für Forschung in der Operativen Medizin, Fakultät für Gesundheit, Chirurgisches Regionalzentrum des CHIR-Net Witten/Herdecke-Köln, Universität Witten/Herdecke, Standort Köln, Ostmerheimer Str. 200, Haus 38, 51109, Köln, Deutschland
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Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg 2014; 134:359-70. [PMID: 24305696 DOI: 10.1007/s00402-013-1882-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Indexed: 01/18/2023]
Abstract
PURPOSE Olecranon bursitis and prepatellar bursitis are common entities, with a minimum annual incidence of 10/100,000, predominantly affecting male patients (80 %) aged 40-60 years. Approximately 1/3 of cases are septic (SB) and 2/3 of cases are non-septic (NSB), with substantial variations in treatment regimens internationally. The aim of the study was the development of a literature review-based treatment algorithm for prepatellar and olecranon bursitis. METHODS Following a systematic review of Pubmed, the Cochrane Library, textbooks of emergency medicine and surgery, and a manual reference search, 52 relevant papers were identified. RESULTS The initial differentiation between SB and NSB was based on clinical presentation, bursal aspirate, and blood sampling analysis. Physical findings suggesting SB were fever >37.8 °C, prebursal temperature difference greater 2.2 °C, and skin lesions. Relevant findings for bursal aspirate were purulent aspirate, fluid-to-serum glucose ratio <50 %, white cell count >3,000 cells/μl, polymorphonuclear cells >50 %, positive Gram staining, and positive culture. General treatment measures for SB and NSB consist of bursal aspiration, NSAIDs, and PRICE. For patients with confirmed NSB and high athletic or occupational demands, intrabursal steroid injection may be performed. In the case of SB, antibiotic therapy should be initiated. Surgical treatment, i.e., incision, drainage, or bursectomy, should be restricted to severe, refractory, or chronic/recurrent cases. CONCLUSIONS The available evidence did not support the central European concept of immediate bursectomy in cases of SB. A conservative treatment regimen should be pursued, following bursal aspirate-based differentiation between SB and NSB.
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