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Published on: February 25, 2022
A clinical analysis of shoulder and hip joint infections in children
Mohan V Belthur1, Debra L Palazzi, Jerry A Miller
1Pediatric Orthopaedics and Scoliosis Surgery, Texas Children's Hospital, Houston, TX 77030, USA. jweinb2000@yahoo.com
Insights
Pediatric shoulder septic arthritis presents later and is more complex than hip infections. Children with shoulder infections require longer treatment and face higher risks of skeletal complications.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Rheumatology
Background:
- Septic arthritis of the shoulder is a rare but serious infection in children.
- Prompt surgical drainage and antibiotics are crucial to prevent joint damage and osteomyelitis.
- Delayed treatment can lead to significant long-term complications.
Purpose of the Study:
- To compare the clinical course of septic arthritis of the shoulder with that of septic arthritis of the hip in children.
- To identify differences in presentation, treatment, and outcomes between shoulder and hip infections.
- To highlight the unique challenges associated with pediatric shoulder septic arthritis.
Main Methods:
- Retrospective comparative study of 9 children with shoulder septic arthritis and 14 with hip septic arthritis.
- Data collected included medical records, laboratory tests, and radiographic findings.
- All patients underwent surgical drainage via open arthrotomy.
Main Results:
- Shoulder infections showed significantly different admission parameters (temperature, WBC, ESR) compared to hip infections.
- Presentation was notably delayed in the shoulder group (P=0.012).
- Higher rates of adjacent osteomyelitis (67% vs 36%), repeat surgery (P=0.056), and longer hospitalizations (P=0.028) were observed in shoulder infections.
Conclusions:
- Pediatric septic arthritis of the shoulder often presents later and follows a more complicated course than hip infections.
- Children with shoulder infections require extended treatment durations and have an increased risk of skeletal complications.
- Early recognition and intervention are vital for optimal outcomes in pediatric shoulder septic arthritis.
Background:
Septic arthritis of the shoulder is a rare infection in healthy children. This infection requires prompt surgical drainage and antibiotic treatment. A delay in surgical intervention can result in damage to the articular surface of the glenohumeral joint, adjacent osteomyelitis, and possible growth disturbance. The clinical course of septic arthritis of the shoulder was compared with that of septic arthritis of the hip, a more common disease in children.
Methods:
We identified 9 children with infections of the glenohumeral joint who presented to our pediatric hospital between 2001 and 2007. The average age at presentation was 7 years (range: 7 mo to 12 y). These patients were compared with 14 selected patients treated for septic arthritis of the hip (mean age 7 y, range: 1 to 12 y). Surgical drainage was performed by open arthrotomy in each case. A retrospective review and analysis of the medical records, laboratory tests, and radiographs of these patients were performed.
Results:
Children with shoulder infections differed significantly (P<0.05) from patients with hip infections with regard to temperature, white blood cell count, and erythrocyte sedimentation rate at the time of admission. The average time from the onset of symptoms to presentation was notably longer in the shoulder group compared with the hip group (P=0.012). Adjacent osteomyelitis was found in 67% of the shoulders and 36% of the hips (P=0.214). Children suffering from septic arthritis of the shoulder showed higher rates of repeat surgical drainage (P=0.056) and extended hospitalizations (P=0.028). The total duration of antibiotics was longer in the shoulder group (P=0.059).
Conclusions:
Septic arthritis of the shoulder in the pediatric population often has a delayed presentation with a more complicated disease course than an infection of the hip. Children with shoulder infections require a longer duration of treatment and may experience a higher likelihood of skeletal complications.
Level Of Evidence:
Level III, retrospective comparative study.
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