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An Algorithmic Approach to the Suspected Septic Wrist.
Jeffrey R Claiborne1, Leslie G Branch, Michael Reynolds
1From the Department of Plastic and Reconstructive Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC.
Annals of Plastic Surgery
|February 11, 2017
Summary
Diagnosing septic wrist arthritis is challenging. Prompt treatment with antibiotics and joint drainage, potentially via serial aspirations, is crucial for better outcomes and avoiding surgery.
Area of Science:
- Orthopedics
- Rheumatology
- Infectious Diseases
Background:
- Acutely painful, erythematous wrists present a diagnostic challenge due to a broad differential diagnosis and nonspecific clinical findings.
- No definitive criteria reliably distinguish septic wrist arthritis from sterile inflammatory arthropathy.
- Delayed treatment for septic arthritis significantly worsens patient outcomes.
Purpose of the Study:
- To present evidence-based guidelines and an algorithm for managing acutely inflamed wrists concerning for septic arthritis.
- To address the diagnostic and therapeutic challenges in differentiating septic arthritis from other inflammatory conditions.
- To provide a framework for timely and effective management of suspected septic wrist arthritis.
Main Methods:
- Comprehensive literature review to establish evidence-based guidelines.
- Development of a management algorithm for acutely inflamed wrists.
- Analysis of diagnostic reliability of laboratory and synovial fluid tests.
Main Results:
- Systemic blood laboratory results are variable and unreliable for diagnosis.
- Synovial fluid tests do not always provide diagnostic certainty.
- Concomitant infection with crystal arthropathy is a rare but reported possibility.
Conclusions:
- Prompt antibiotic administration and joint drainage are critical for septic wrist recovery.
- Less invasive approaches like serial aspirations may be as effective as open drainage for septic wrists, with reduced morbidity.
- Admission for systemic antibiotics and daily arthrocentesis is a reasonable initial approach for suspected septic arthritis or crystal arthropathy with infection concerns.
