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[Pediatric septic shoulder arthritis. Is routine arthrotomy still necessary?]
Markus Pääkkönen1, Heikki Peltola, Markku Kallio
1Mikkelin keskussairaala, TYKS:n yleiskirurgian klinikka, PL 52, 20521 Turku.
Insights
Routine arthrotomy for pediatric septic shoulder arthritis is questionable. A diagnostic aspiration followed by antibiotics proved effective, with no adverse outcomes in nine children.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Musculoskeletal Infections
Context:
- Septic arthritis of the shoulder in children is often treated with arthrotomy.
- There is a lack of scientific evidence supporting routine arthrotomy.
- Alternative treatments include arthroscopic lavage, serial aspirations, and diagnostic aspiration.
Purpose:
- To evaluate the efficacy of diagnostic aspiration and antibiotic treatment for pediatric septic shoulder arthritis.
Summary:
- Nine children (3 months to 12 years) with septic shoulder arthritis underwent diagnostic aspiration.
- All patients received high-dose antibiotics (clindamycin or cephalosporin) four times daily.
- Only one child required arthrotomy; the rest recovered without sequelae.
Impact:
- This study questions the routine use of arthrotomy for pediatric septic shoulder arthritis.
- Diagnostic aspiration and prompt antibiotic administration appear to be effective alternatives.
- These findings may influence treatment guidelines for this condition.
Background:
Arthrotomy is recommended as a routine treatment for childhood septic arthritis of the shoulder, although scientific evidence is lacking. Suggested alternatives are arthroscopic lavage, serial aspirations and a mere diagnostic aspiration.
Material And Methods:
9 patients with septic arthritis of the shoulder aged 3 months to 12 years underwent a diagnostic aspiration after which large dose antimicrobials were given qid (clindamycin or 1st generation cephalosporin).
Results:
One child underwent arthrotomy, otherwise all patients recovered normally. There were no sequelae.
Conclusions:
Routine arthrotomy for all patients is of questionable value in the emergency treatment of septic shoulder arthritis in children.