Abstract
BackgroundSeptic arthritis of the elbow joint is a rare condition. Limited data is available on infections of the elbow joint following trauma or prior surgery on this joint. The aim of this study was to describe the etiology, comorbidities, bacterial spectrum and therapy of secondary purulent elbow infections.MethodsPatients treated in our hospital were selected through retrospective chart review between 2006 and 2015. We included all patients with an empyema of the elbow after a trauma or surgical intervention on this joint. 30 patients between 26 and 82 years (mean: 52.47) were included.ResultsSeven patients (23.3%) were female, 23 (76.7%) male. 22 patients (73.3%) had a history of trauma, eight (26.7%) had prior elective surgeries on their elbow. Between one and 25 surgeries (mean: 5.77) were necessary for treatment. In nine patients, debridement and synovectomy were sufficient, eight patients (26.7%) received resection of the elbow joint. One patient was treated with a chronic fistula. In 18 patients (60%), cultures of aspiration/intraoperative swabs were positive for Staphylococcus aureus, four of these were methicillin-resistant. Four patients (13.3%) had positive cultures for Staphylococcus epidermidis, in five patients (16.7%) no bacteria could be cultured.ConclusionsSecondary infections of the elbow joint are a rare disease with potentially severe courses, requiring aggressive surgical treatment and possibly severely impacting elbow function. Staphylococcus aureus was the most common bacteria in secondary infections and should be addressed by empiric antibiotic treatment when no suspicion for other participating organisms is present.
Highlights
Septic arthritis of the elbow joint is a rare condition
We found 32 patients suffering a septic arthritis of the elbow after a trauma (n = 24) or after elective surgery of the elbow joint (n = 8) in the relevant period
We reviewed the medical charts of the patients for the following features: age, sex, comorbidities, mortality, laboratory parameters (C-reactive protein (CRP), white blood cell count (WBC)), findings in microbial cultures, presentation after onset of the symptoms, number of surgical procedures, definitive therapy and documented range of motion before dismissal
Summary
Septic arthritis of the elbow joint is a rare condition. Septic monoarticular arthritis has an annual incidence of 2–5/100,000 in the USA with higher rates in patients with rheumatoid diseases or prostheses of the respective joint [1]. Infected joints are considered to be an orthopedic emergency, with correct diagnosis and rapid treatment being of utmost importance. Diagnosis of an infected joint can be challenging, since neither laboratory investigations nor imaging of a joint provides sufficient specificity or sensitivity for proof. Septic arthritis of the elbow joint remains a rare but devastating condition. The elbow is the third most affected joint in mono-articular septic arthritis, in a UK-based study it was shown to be present in about 9% of the cases [5].
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