Gupta Gaurav, Chaudhary Manu, Khunt Aliraza, Shah Viral, Shah Maulin M
Clinical Fellow (Paediatric Orthopaedics) at OrthoKids Clinic, Drive-in Road, Ahmedabad, India.
Infectious Diseases Consultant (American Board Certified), Pediatrics and Infectious Diseases Centre, Ahmedabad, Gujarat, India & Apollo Hospital International Limited, Ahmedabad, Gujarat, India.
J Clin Orthop Trauma. 2020 Mar-Apr;11(2):328-331. doi: 10.1016/j.jcot.2019.02.002. Epub 2019 Feb 5.
Septic Arthritis of the wrist is rare in the paediatric population due to its extraarticular metaphysis. We report here a case of wrist septic arthritis in a neonate caused by an uncommon causative organism, A 15 days old male child was referred with the complaint of swelling and decreased movement of the left wrist for 5 days. Local examination revealed warm, tender, erythematous and fluctuant swelling over the dorso-ulnar aspect of the left wrist. Ultrasonography of the affected region was suggestive of focal fluid collection in the wrist and periosteal elevation of the distal ulna. Aspiration followed by arthrotomy of the wrist joint was performed and multiple holes were made in the distal ulnar metaphysis using 0.8mm k-wire. The pus culture was positive for sensitive to vancomycin, which was given for a total of 4 weeks. At one year follow up the child had a full, painless range of motion with no functional deficit. Final follow up x rays of the left wrist were normal. strains are described as Gram-positive, catalase-negative cocci, approximately 1 μm in diameter growing in chains and were originally isolated from the human throat and oral cavities. Its association with bone and joint infections has not been described in the literature. To our knowledge, this is the first case of isolated septic arthritis of wrist in a 15 days old child caused by To conclude, wrist septic arthritis in a neonate is a rare entity. With the advanced diagnostics, species-level identification of rare organism like is possible along with antibiotic sensitivity for appropriate therapy. Early surgical decompression and intravenous culture-directed antibiotics are the mainstays of management.
由于腕关节的干骺端位于关节外,小儿腕关节化脓性关节炎较为罕见。我们在此报告一例新生儿腕关节化脓性关节炎,其致病微生物不常见。一名15天大的男童因左腕肿胀及活动减少5天前来就诊。局部检查发现左腕背尺侧温暖、压痛、红斑且有波动感肿胀。对患区进行超声检查提示腕关节有局灶性液体积聚及尺骨远端骨膜抬高。随后进行了腕关节穿刺及切开术,并使用0.8mm克氏针在尺骨远端干骺端钻了多个孔。脓液培养对万古霉素敏感,结果呈阳性,患儿总共接受了4周的万古霉素治疗。在1年的随访中,患儿腕关节活动范围正常且无痛,无功能缺陷。左腕的最终随访X线片正常。该菌株被描述为革兰氏阳性、过氧化氢酶阴性球菌,直径约1μm,呈链状生长,最初是从人的咽喉和口腔中分离出来的。其与骨和关节感染的关联在文献中尚未有描述。据我们所知,这是首例由该菌株引起的15天大儿童孤立性腕关节化脓性关节炎。总之,新生儿腕关节化脓性关节炎是一种罕见疾病。借助先进的诊断方法,可以对像该菌株这样的罕见微生物进行种属鉴定,并确定抗生素敏感性以进行适当治疗。早期手术减压及静脉应用针对培养结果的抗生素是主要治疗方法。