Department of Orthopaedics and Trauma Surgery, EHC, Morges, Vaud, Switzerland
Department of Orthopaedics, Trauma and Spine Surgery, St Josefs Hospital, Wiesbaden, Hessen, Germany.
BMJ Case Rep. 2021 Mar 25;14(3):e239020. doi: 10.1136/bcr-2020-239020.
The early diagnosis of low-grade prosthetic shoulder joint infection is challenging due to the lack of clinical and laboratory signs. Patients present with atypical symptoms such as stiffness or failure to improve shoulder function. The diagnosis is often delayed with impact on long-term outcomes. We present the case of an 82-year-old man with a surgical site erythema occurring 7 weeks after reverse shoulder arthroplasty associated with a light raise of C reactive protein (20 mg/L). At 9 weeks, radiographs revealed a 'periosteal spur sign' (humeral calcar) and localised adjacent osteolysis. Open surgery showed morphological signs of infection confirmed by growth of in eight cultures. A 'periosteal spur sign' is a useful early radiographic indicator of low-grade prosthetic joint infection usually occurring with some delay after clinical symptoms. A high clinical index of suspicion is needed to proceed with biopsies and to initiate combined operative and antibacterial treatment.
早期诊断低级别人工肩关节感染具有挑战性，因为缺乏临床和实验室迹象。患者表现出非典型症状，如僵硬或肩部功能无法改善。由于诊断延迟，会对长期结果产生影响。我们报告了一例 82 岁男性的病例，他在反肩关节置换术后 7 周出现手术部位红斑，伴有 C 反应蛋白轻度升高（20mg/L）。9 周时，放射线照片显示“骨膜刺状征”（肱骨骨突）和局部相邻骨质溶解。开放性手术显示感染的形态学迹象，8 种培养物均证实有生长。“骨膜刺状征”是一种有用的早期放射影像学指标，通常在临床症状出现后出现一定延迟。需要高度怀疑临床症状，进行活检，并开始联合手术和抗菌治疗。
