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Arthroscopic treatment of septic arthritis of the shoulder in a 6-year-old boy
Giovanni Luigi Di Gennaro1, Camilla Bettuzzi, Diego Antonioli
1Department of Pediatric Orthopedics and Traumatology, Istituto Ortopedico Rizzoli, Bologna, Italy.
Insights
Septic arthritis of the shoulder in children is rare and challenging to diagnose. Shoulder arthroscopy offers a viable treatment option, even in advanced cases, leading to excellent outcomes and full range of motion recovery.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Surgical Innovation
Background:
- Septic arthritis of the shoulder in children is uncommon, often leading to diagnostic delays and significant sequelae.
- Potential complications include humeral shortening, joint instability, premature arthritis, and limited range of motion.
Observation:
- A 6-year-old boy with persistent shoulder pain and dysfunction despite prior antibiotic therapy and arthrocentesis.
- Advanced imaging confirmed Stage IV septic arthritis with osseous involvement.
Findings:
- Arthroscopic management including irrigation, debridement, synoviectomy, and osteochondral erosion shaving was performed.
- Post-operative intravenous and oral antibiotic therapy was administered.
- At 22-month follow-up, the patient was asymptomatic with full range of motion and no limb length discrepancy.
Implications:
- Arthroscopic treatment is an effective option for pediatric shoulder septic arthritis, even in advanced stages.
- This minimally invasive approach can yield favorable results, preserving joint function.
- Open arthrotomy should be reserved for cases with concurrent bone infection unresponsive to arthroscopic treatment.
Abstract:
Septic arthritis of the shoulder in children is a rare condition. The diagnosis may present some difficulties and, consequently, appropriate treatment often is delayed. Main sequelae are humeral shortening, joint instability, premature arthritis and limited range of motion. We report a case of septic arthritis of the shoulder in a child who was treated by means of shoulder arthroscopy. A 6-year-old boy presented with a history of fever, pain and functional impairment of the shoulder that were lasting despite having undergone antibiotic therapy for 28 days (amoxicillin per os, and then teicoplanin intravenously combined with meropenem intravenously) and an arthrocentesis (no organisms were identified) in another hospital. Clinical examination (pain, swelling, warmness, functional impairment), laboratory tests (white blood cell count, 6.900/mm(3); C-reactive protein, 6.44 mg/dL; erythrocyte sedimentation rate, 119 mm), and imaging studies (radiographs, ultrasonography, computed tomography scan, magnetic resonance imaging, bone scan) performed in our department suggested the diagnosis of a stage IV (with osseous involvement) septic arthritis. Arthroscopic irrigation, debridement, synoviectomy and shaving of the osteochondral erosions were performed, in association with antibiotic therapy (teicoplanin and ceftriaxone disodium intravenously, and then amoxicillin/clavulanate per os). At 22-month follow-up, the patient was asymptomatic and showed a full range of motion. No limb length-discrepancy was found. Radiographs showed irregular profile of the humeral epiphysis without any physeal disturbances. Arthroscopic treatment for septic arthritis of the shoulder in children, though rarely reported, represents an adequate procedure for cases without bone involvement and may lead to good results, even in stage IV cases. Open arthrotomy should be reserved for cases with concomitant osseous infection after failure of arthroscopic treatment.