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See Latest ArticlesComparison of arthroscopic and open treatment of septic arthritis of the wrist
Journal of Bone and Joint Surgery, 06/02/09
Sammer DM et al. – Study demonstrates that arthroscopic irrigation and débridement is an effective treatment for patients with isolated septic arthritis of the wrist; these patients had fewer operations and a shorter hospital stay than did patients who had received open treatment. However, these benefits were not seen in patients with multiple sites of infection.
Methods- A comparison of arthroscopic and open techniques in pts with septic arthritis of wrist
- Pts initially treated over an 11-year period, with open or arthroscopic irrigation and débridement
- Clinical presentation, laboratory and microbiological findings, hospital course, complications, and outcomes were compared between the 2 groups
- Between 1997 and 2007, 36 pts with septic arthritis involving a total of 40 wrists were identified
- 19 wrists (17 pts) were initially treated with open irrigation and débridement, and 21 wrists (19 pts) were initially treated arthroscopically
- 11 wrists in the open-treatment cohort required repeat irrigation and debridement
- 8 wrists in the arthroscopy cohort required a repeat procedure
- If a repeat irrigation and débridement was required, it was performed in an open fashion in all but 2 cases
- No patient treated with arthroscopic irrigation and débridement required a second operation
- The pts who went through open method stayed longer in in the hospital
- The 90-day perioperative mortality rate in the series was substantial
Douglas M. Sammer, 06/16/09
| Although arthroscopy has proven very useful for treating septic arthritis in large joints such as the knee and hip, arthroscopic I&D of the wrist has not been previously evaluated. This study demonstrates potential advantages to arthroscopic I&D of the wrist. However, some questions remain unanswered. For example, does the chronicity of the infection affect which treatment method (open vs. arthroscopic) should be used? A prospective randomized study would provide more useful information about the indications, advantages, and disadvantages of arthroscopic versus open I&D. Because of the relatively low incidence of septic arthritis in the wrist, this would likely require a multi-center collaborative effort. |
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