172 Septic Arthritis of the Wrist: Audit of Management and Awareness of National Guidelines Amongst Orthopaedic Surgeons in a District General Hospital

Abstract

Abstract Aim Septic arthritis (SA) of the wrist is relatively uncommon and, in contrast to SA of large joints, can safely be managed with serial aspiration to dryness rather than traditional open surgical drainage. This is supported by BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. We conducted an audit of management of suspected wrist SA patients and surveyed awareness of relevant guidelines amongst orthopaedic surgeons. Method Electronic records of patients referred as suspected wrist SA to the orthopaedic department over a six-month period (August 2020 to February 2021) were retrospectively reviewed. Data analysis included demographics, diagnosis, management, and treatment outcome. In addition, knowledge of wrist SA management amongst orthopaedic medical staff was determined via a multiple-choice questionnaire. Results 11 patients were identified (5M:6F, age range 62–91). 6/11 patients underwent wrist aspiration though only one patient had a positive gram stain. No patients underwent serial aspiration as advocated by national guidelines. 2/11 patients underwent formal surgical washout in theatre. 15 orthopaedic doctors were surveyed (8 Junior Doctors, 4 Registrars, 3 Consultants). 2/15 were aware of national guidelines. 11/15 chose joint aspiration as an initial investigation. 2/15 considered repeated joint aspiration to dryness as definitive management. Conclusions This audit highlighted low compliance with national guidelines when managing wrist SA, although this did not adversely affect patient outcomes. We demonstrated lack of awareness of relevant guidelines amongst orthopaedic surgeons. We propose relevant teaching and incorporation of national guidelines into Trust policy.