Jennings John D, Zielinski Elizabeth, Tosti Rick, Ilyas Asif M
Orthopedics. 2017 May 1;40(3):e526-e531. doi: 10.3928/01477447-20170404-01. Epub 2017 Apr 11.
Septic arthritis of the wrist can result in permanent damage to the joint, making timely diagnosis crucial to initiate empiric antibiotics and surgical intervention. Although septic arthritis is routinely included in the differential diagnosis of atraumatic wrist pain, the incidence is unknown. Unlike large joints, there is no consensus on cell count values considered pathognomonic for wrist septic arthritis. The goal of this retrospective study was to determine the incidence of wrist septic arthritis and to identify the clinical, serum, and joint fluid values that predict infection. The records of patients who presented to a single urban hospital with a swollen, painful wrist without trauma during a 10-year period were reviewed. For patients who had a joint fluid analysis, the records were examined for history as well as demographic and laboratory data. Joint fluid analysis consisted of cell count, Gram stain, and cultures. Of 892 patients who met the inclusion criteria, 1.5% had wrist septic arthritis. Variables associated with septic arthritis included serum white blood cell count above 11,000/µL, core temperature above 100.4°F within 24 hours of aspiration, history of intravenous drug abuse, and smoking. No joint cell count analysis predicted septic arthritis, although patients with septic wrists had an elevated joint white blood cell count above 97,000/µL. Wrist septic arthritis is uncommon; however, objective factors can help identify patients at risk. Because joint cell count analysis cannot reliably predict a septic wrist, priority for joint aspirations with limited fluid should be given instead to Gram stain, culture, and crystal analysis. [Orthopedics. 2017; 40(3):e526-e531.].
腕关节化脓性关节炎可导致关节永久性损伤，因此及时诊断对于启动经验性抗生素治疗和手术干预至关重要。尽管化脓性关节炎通常被纳入非创伤性腕关节疼痛的鉴别诊断中，但其发病率尚不清楚。与大关节不同，对于腕关节化脓性关节炎具有诊断意义的细胞计数数值尚无共识。这项回顾性研究的目的是确定腕关节化脓性关节炎的发病率，并确定可预测感染的临床、血清和关节液数值。回顾了10年间在一家城市医院就诊的、腕部肿胀疼痛且无外伤的患者记录。对于进行了关节液分析的患者，检查其病史以及人口统计学和实验室数据。关节液分析包括细胞计数、革兰氏染色和培养。在892名符合纳入标准的患者中，1.5%患有腕关节化脓性关节炎。与化脓性关节炎相关的变量包括血清白细胞计数高于11,000/µL、穿刺后24小时内核心体温高于100.4°F、静脉药物滥用史和吸烟史。尽管化脓性腕关节患者的关节白细胞计数高于97,000/µL，但没有关节细胞计数分析能够预测化脓性关节炎。腕关节化脓性关节炎并不常见；然而，客观因素有助于识别高危患者。由于关节细胞计数分析不能可靠地预测化脓性腕关节，因此对于液体有限的关节穿刺，应优先进行革兰氏染色、培养和晶体分析。[《骨科学》。2017年；40(3):e526 - e531。]
