Abstract
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.]
- 1.Yap RT, Tay SC. Wrist septic arthritis: an 11 year review. Hand Surg. 2015; 20(3):391–395.
10.1142/S021881041550029X Crossref Medline, Google Scholar - 2.Sammer DM, Shin AY. Comparison of arthroscopic and open treatment of septic arthritis of the wrist. J Bone Joint Surg Am. 2009; 91(6):1387–1393.
10.2106/JBJS.H.00630 Crossref Medline, Google Scholar - 3.Mehta P, Schnall SB, Zalavras CG. Septic arthritis of the shoulder, elbow, and wrist. Clin Orthop Relat Res. 2006; 451:42–45.
10.1097/01.blo.0000229322.30169.29 Crossref Medline, Google Scholar - 4.Birman MV, Strauch RJ. Management of the septic wrist. J Hand Surg Am. 2011; 36(2):324–326.
10.1016/j.jhsa.2010.11.034 Crossref Medline, Google Scholar - 5.Skeete K, Hess EP, Clark T, Moran S, Kakar S, Rizzo M. Epidemiology of suspected wrist joint infection versus inflammation. J Hand Surg Am. 2011; 36(3):469–474.
10.1016/j.jhsa.2010.10.033 Crossref Medline, Google Scholar - 6.Rashkoff ES, Burkhalter WE, Mann RJ. Septic arthritis of the wrist. J Bone Joint Surg Am. 1983; 65(6):824–828.
10.2106/00004623-198365060-00015 Crossref Medline, Google Scholar - 7.Hunter JG, Gross JM, Dahl JD, Amsdell SL, Gorczyca JT. Risk factors for failure of a single surgical debridement in adults with acute septic arthritis. J Bone Joint Surg Am. 2015; 97(7):558–564.
10.2106/JBJS.N.00593 Crossref Medline, Google Scholar - 8.Roberts J, Schaefer E, Gallo RA. Indicators for detection of septic arthritis in the acutely swollen joint cohort of those without joint prostheses. Orthopedics. 2014; 37(2):e98–e102.
10.3928/01477447-20140124-09 Link, Google Scholar - 9.Mathews CJ, Weston VC, Jones A, Field M, Coakley G. Bacterial septic arthritis in adults. Lancet. 2010; 375(9717):846–855.
10.1016/S0140-6736(09)61595-6 Crossref Medline, Google Scholar - 10.Schuind FA, Remmelink M, Pasteels JL. Coexistent gout and septic arthritis at the wrist: a case report. Hand Surg. 2003; 8(1):107–109.
10.1142/S0218810403001406 Crossref Medline, Google Scholar - 11.McConville JH, Pototsky RS, Calia FM, Pachas WN. Septic and crystalline joint disease: a simultaneous occurrence. JAMA. 1975; 231(8):841–842.
10.1001/jama.1975.03240200039023 Crossref Medline, Google Scholar - 12.Yu KH, Luo SF, Liou LB, Concomitant septic and gouty arthritis: an analysis of 30 cases. Rheumatology (Oxford). 2003; 42(9):1062–1066.
10.1093/rheumatology/keg297 Crossref Medline, Google Scholar - 13.Murray PM. Septic arthritis of the hand and wrist. Hand Clin. 1998; 14(4):579–587. Crossref Medline, Google Scholar
- 14.Quan H, Li B, Saunders LD, Assessing validity of ICD-9-CM and ICD-10 administrative data in recording clinical conditions in a unique dually coded database. Health Serv Res. 2008; 43(4):1424–1441.
10.1111/j.1475-6773.2007.00822.x Crossref Medline, Google Scholar - 15.Zeng X, Bell PD. Determination of problematic ICD-9-CM subcategories for further study of coding performance: Delphi method. Perspect Health Inf Manag. 2011; 8:1b. Medline, Google Scholar
- 16.O'Malley KJ, Cook KF, Price MD, Wildes KR, Hurdle JF, Ashton CM. Measuring diagnoses: ICD code accuracy. Health Serv Res. 2005; 40(5, pt 2):1620–1639.
10.1111/j.1475-6773.2005.00444.x Crossref Medline, Google Scholar
