Septic Arthritis of the Wrist

Bilateral Septic Arthritis of the Wrist With Streptococcus dysgalactiae: A Case Report

CASE

Septic arthritis is an infection of the joint space that can lead to joint destruction, disability, and death. Mortality risk is increased by old age, comorbidities such as decreased kidney function, and involvement of multiple joints. We report a rare case of bilateral septic arthritis of the wrists in a 101-year-old woman who recovered without complications.

CONCLUSION

This case illustrates the necessity of monitoring pain in other joints in cases of monoarticular septic arthritis to rule out polyarticular involvement to prevent long-term complications, morbidity, and mortality.

Surgical Management of Septic Arthritis of the Wrist: An Analysis of Short- and Long-Term Functional and Clinical Outcomes

Septic arthritis of the wrist is a rare but severe condition requiring urgent diagnosis and treatment to prevent joint destruction and functional impairment. The objective of this study was to investigate prognostic parameters and the long-term functional outcomes. This retrospective and prospective cohort study included 44 patients treated for septic arthritis of the wrist between 2008 and 2024. All patients underwent surgical wrist arthrotomy due to concomitant soft tissue involvement, with a median follow-up of 29 months. Clinical outcomes were assessed through total active range of motion (TROM), grip strength, and patient-reported hand function using the DASH questionnaire. Data analysis examined correlations between comorbidities, surgical interventions and long-term outcomes. Staphylococcus aureus was identified in 61.4% of cases, thus being the most common pathogen. Type 2 diabetes mellitus was identified as a risk factor for requiring a higher number of surgeries to control the infection. Patients requiring more invasive procedures showed worse long-term outcomes, with lower grip strength, a limited active range of motion (TROM) and higher DASH scores. Mortality was associated with higher inflammatory markers and older age at the onset of disease. A total of 36.4% of patients were unable to return to work after treatment, while those who successfully returned to work experienced a median recovery period of seven months. The timely initiation of appropriate surgical therapy is essential in the treatment of septic arthritis of the wrist in order to reduce joint damage and associated loss of hand function, particularly in patients with comorbidities such as diabetes mellitus. Studies should focus on comparing different treatment options and developing more targeted rehabilitation strategies to improve functional outcomes.

Upper extremity infection: imaging features with focus on magnetic resonance imaging

Upper extremity infections are frequently seen, especially in individuals with weakened immune system, posttraumatic events, and after surgery procedures. If not properly treated, such conditions can lead to serious consequences, such as movement impairment, amputation, and even mortality. These infections have the potential to spread extensively from their initial site of entry, traversing interconnected spaces either intra or extra-compartmental. Understanding the relevant anatomy is crucial to assess location and stage of infection, since surgical intervention and intravenous antibiotics are usually required. In this article, the authors provide a comprehensive review of the imaging findings of upper extremity infection, focusing on magnetic resonance imaging (MRI). Furthermore, this article sheds light on the pivotal role of radiology in managing hand, elbow, and shoulder infections offering an overview of available treatment options. KEY FINDINGS: Various types of infections affecting the upper extremity will be discussed, including infectious tenosynovitis, deep space infections, septic arthritis, and osteomyelitis. Authors also highlight anatomical spaces, common pathogens, spread routes, and key radiological features of these conditions.

Radiolunate Fusion After Pyogenic Arthritis Caused by Pinning for Scapholunate Dissociation

Infections associated with percutaneous pinning of the fingers occur in a certain percentage of cases; however, osteomyelitis rarely leads to more severe suppurative arthritis of the hand. A 26-year-old woman presented with scapholunate dissociation and underwent percutaneous pinning. Although some signs of infection were found around the pin site at five weeks, the pins were removed seven weeks postoperatively. At 10 weeks, she experienced severe wrist pain, with radiography, computed tomography, and magnetic resonance imaging confirming distractive changes in the lunate, radius, and pyogenic arthritis. Consequently, the infection was controlled; however, it led to radiolunate fusion. A case of percutaneous pinning followed by lunate osteomyelitis or pyogenic wrist arthritis leading to radial lunate fusion has not been reported previously. The pin should be removed immediately if it becomes infected.

Evaluation of predictive factors of septic wrist to avoid overdiagnosis

BACKGROUND

The existing diagnostic criteria for septic wrist are nonspecific, exposing patients with noninfectious etiologies to surgical morbidity. This study aimed to identify predictors differentiating septic wrist from other etiologies.

METHODS

An institutional review board-approved retrospective review was conducted on patients with a presumed diagnosis of septic wrist (2003-2022). Bivariate and multiple regression analyses were performed to identify correlation between confirmed septic wrist and comorbidities (autoimmune diseases, immunosuppression, crystalline arthropathy, intravenous [IV] drug use, smoking), penetrating trauma, fever, multi-joint involvement, inflammatory markers (erythrocyte sedimentation rate [ESR]/C-reactive protein [CRP]/white blood cells [WBC]), serum uric acid level, blood cultures, imaging findings, and synovial fluid analysis. Categorical data were reported as median [interquartile range].

RESULTS

Hundred and sixty-eight (58 females and 110 males) patients were included. The median length of hospitalization and follow-up were 6[7] days and 1[3] months. Eighty-nine (53%) patients had septic wrist confirmed with Gram stain/culture, 48 (29%) patients received alternative diagnoses, and 31 (18%) patients had undetermined diagnoses. Concomitant septic wrist and crystalline arthropathy were identified in 9 patients (6.6% of total patients). Out of the 48 patients who received alternative diagnoses, 12 (25%) underwent open drainage. Elevated synovial WBC count (95,409.4 ± 85,926.2) showed a trend of association with septic wrist (p = 0.08). Negative synovial crystals (p = 0.01), positive blood culture (p = 0.04), negative history of crystalline arthropathy (p = 0.08), and multi-joint involvement (p = 0.05) were identified as predictors of septic wrist with a combined sensitivity of 87.5%, specificity of 86.2%, and area under the curve 0.93.

CONCLUSIONS

Current diagnostic criteria for septic wrist have low specificity. Negative history of crystalline arthropathy, multi-joint involvement, absence of synovial crystals, and positive blood culture are helpful indicators for predicting septic wrist in patients presenting with a painful, erythematous, and swollen wrist.

Management of the Septic Wrist: A Systematic Review of Etiology and Therapeutic Strategies

Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.

Safe and Effective Aspirations and Nerve Blocks for the On-Call Orthopaedic Surgeon

The on-call orthopaedic surgeon is faced with a wide array of orthopaedic pathology for which intra-articular aspiration, injection, and/or nerve/hematoma block may be used. Efficient use of these diagnostic and therapeutic modalities affords better patient care and a more effective on-call period. Often, these interventions are the rate limiting factor in a reduction or diagnosis. In this review, we describe joint aspirations, saline load tests, hematoma blocks, and nerve blocks in detail to include their indications, techniques, related pharmacology, pearls, and pitfalls.

Infection Management for the Hand Surgeon

Infections of the upper extremity can be challenging to diagnose and treat because of the complex anatomy and range of offending pathogens. Early recognition of infections that require an emergent surgical intervention, such as necrotizing fasciitis and septic joints, is imperative for good clinical outcomes. In addition, prompt diagnosis and intervention for deep closed space infections, such as deep abscesses or flexor tenosynovitis, is necessary to avoid chronic pain and dysfunction. Complicating factors such as underlying osteomyelitis, atypical pathogens, and immunocompromised states of patients should always be considered when treating upper-extremity infections.

Aspergillus fumigatus Septic Arthritis of the Wrist: A Report of a Rare Case in an Immunocompromised Patient

Aspergillus fumigatus is a saprophytic fungus encountered as a pathogen in airborne lung infections. Although it commonly causes pulmonary infectious diseases, when disseminated, it may cause a systemic infection termed invasive aspergillosis, which is associated with high mortality and morbidity. Virtually, all organ systems may be involved. However, the musculoskeletal system is relatively uncommon. Here, we present a case of invasive aspergillosis in an immunocompromised patient involving the wrist joint, an exceedingly rare site. Our treatment choice is serial open debridement, irrigation, and intravenous antibiotics. This case study exemplifies the potential challenges in the identification and treatment of such an uncommon clinical condition. A thorough clinical and microbiological evaluation is essential for accurate diagnosis of fungal septic arthritis of the wrist. Aggressive early surgical treatment combined with appropriate early intravenous antibiotics is crucial for eradicating joint infection.

Arthroscopic Versus Open Treatment of Septic Wrist Arthritis: National Trends in Usage and Impact on Length of Stay, Reoperation, Postoperative Readmissions, and Complications

Purpose

The purpose of this study was to use a national claims database to analyze trends in the usage of arthroscopic versus open irrigation and debridement of septic wrist arthritis and compare complication rates, readmission rates, and reoperation rates between the 2 treatment modalities.

Methods

The PearlDiver database was used to identify patients in the United States who underwent open or arthroscopic debridement for suspected septic wrist arthritis from 2010 to 2017. Data on patient demographics and comorbidities were obtained. Pearson's chi-square tests were performed to compare the treatment modality to demographic data and the year of diagnosis. Univariate logistic regressions were used to measure differences in 90-day hospital readmission rates, 90-day complication rates, and 1-year reoperation rates.

Results

The database captured 1,145 patients who received treatment for septic arthritis of the wrist during this period. Among these, 212 (18.5%) patients underwent arthroscopic debridement and 933 (81.5%) patients underwent open debridement. Open management was more common in all ages; however, arthroscopic debridement was used more frequently in younger age groups. The proportion of open cases per year seemed to increase over the study period. In limited comparisons, no significant differences were observed in 90-day hospital readmission rates, 90-day complication rates, and 1-year reoperation rates.

Conclusions

Open irrigation and debridement was the preferred method for treatment of septic wrist arthritis in all age groups and time points in this study. No univariate differences were found between rates of readmission, complications, and reoperations between arthroscopic and open treatment modalities; however, more robust data and analyses are needed to better understand the differences between these approaches, especially across different patient groups.

Level of evidence

Prognostic IV.

Septic arthritis of the wrist: a retrospective review of 39 cases

LEVEL OF EVIDENCE

III.

Spontaneous Pan-Carpal Metacarpal Fusion After a Case of Pediatric Septic Arthritis of the Wrist: A Case Report

CASE

A 46-year-old female patient with a history of Streptococcus pyogenes septic arthritis 32 years earlier presented to an outpatient clinic with complaints of chronic wrist pain and stiffness. Imaging revealed complete pan-carpal metacarpal fusion with advanced radiocarpal arthritis. The patient's pain improved with 3 months of nonoperative management, and she was able to return to previous levels of activity.

CONCLUSIONS

Pediatric septic arthritis of the wrist is an exceedingly rare diagnosis but may result in spontaneous complete pan-carpal metacarpal fusion.

The Use of Ultrasound to Differentiate Between Gout and Infection in the Wrist

Background:

Gout is a common condition and its prevalence is increasing. In the wrist, acute gouty arthritis is difficult to distinguish from infection and may occur concomitantly. Though aspiration is helpful, it is not always technically feasible or definitive. Imaging may assist in the differential diagnosis.

Case Presentation:

Two cases are described in which the use of ultrasound evaluation assisted in the diagnosis and ultimate treatment.

Conclusion:

Ultrasound can be a helpful adjunct in the diagnosis of arthritis of the wrist, helping to tailor treatment in complex cases.

Granulocytic Sarcoma: A Rare Cause of Wrist Pain

Septic, inflammatory, or crystal-induced arthritis are common etiologies of wrist pain without antecedent trauma associated with pain, loss of motion, swelling, redness, and warmth. In this report, we detail the case of granulocytic sarcoma of the wrist that presented as acute wrist pain, swelling, and limitation in motion. Granulocytic sarcoma is an exceedingly rare extramedullary tumor associated with acute myeloblastic leukemia. It may be found in any part of the body; however, upper extremity involvement is uncommon. To our knowledge, this is the first description of granulocytic sarcoma occurring in the wrist joint.

Septic Arthritis of the Pediatric Wrist: A Case Report and Review of the Literature

Septic arthritis of the wrist in pediatric patients is a rare diagnosis and is not well described in the literature. We present a case of a 4-month old patient with monoarticular septic arthritis of the wrist treated with surgical drainage and antibiotics. Although a rare diagnosis, septic arthritis of the wrist should be considered in patients with pseudoparalysis of the upper extremity and systemic signs of inflammation. Prompt diagnosis and treatment is critical to prevent permanent damage to the joint. Further data is needed to describe the epidemiology, microbiology, diagnostic findings and treatment of septic arthritis of the pediatric wrist.

Septic arthritis of the wrist: about six cases

The wrist is a rare location of septic arthritis. It often involves patients with preexisting joint disease which symptoms could be confused with infection making the diagnosis more difficult and usually delayed. It is often responsible for residual functional impairment and for a high mortality rate among vulnerable patients. We report 6 cases of septic arthritis of the wrist in 3 males and 3 females. The mean age was 32 years in the male patients and 66 in the female patients. All the women were followed for rheumatoid arthritis. Biological results showed elevated rates of white blood cells and c-reactive protein in all the patients. Joint fluid analyses showed elevated white blood cell count. The treatment was medico-surgical consisting in synovectomy, joint debridement and immobilization of the wrist. At the average follow-up of 1 year and 4 months, 3 patients recovered a perfect mobility of the wrist without any limitation of the range of motion nor the strength. Three patients developed stiffness of the wrist.