Olecranon Bursitis Research Articles

Functional Outcome of Isolated Middle to Distal Third Ulnar Shaft Fracture in Adults with Square Nail Fixation

Introduction: Isolated ulnar shaft are uncommon injuries with most of the fractures occurring following direct trauma. Open reduction and internal fixation with plating is the gold standard treatment but is associated with complications. Treatment with square nail provides rotational stability, is cheaper, safer with minimum complications of plating.
 Aims: To evaluate the functional outcome of isolated fracture of middle third to distal third ulna treated with square nail.
 Methods: This prospective observational study was conducted in the Department of Orthopedics at Nepalgunj Medical College Teaching Hospital Kohalpur from September 2018 to August 2022. Patients aged above 18 and below 60 years who had displaced isolated fracture of middle third or distal third of ulna were evaluated for demographic details, union, functional outcome and associated complications. All of the fractures of ulna were treated by square nail and outcomes were evaluated using disability of arm, shoulder and hand (DASH) score and Grace and Eversmann scoring system.
 Results: In this study of 39 patients with the mean age of 30.84±8.12 years, 56.4% of the patients were in age group 18-30 years, 27 (69.2%) were males and 12 (30.8%) were females. The right limb was fractured in majority, distal third was more commonly involved, physical assault was the most common mode of injury, transverse was the most common fracture pattern. The average time to union was 11.61±2.74 weeks. Most (74.4%) of the patients had good result in DASH score and most (94.9%) had good to excellent result in Grace and Eversmannscoring at final follow-up. The most common complication noted was olecranon bursitis (17.94%) followed by skin irritation (12.82%).
 Conclusion: Square nail fixation of isolated middle third to distal third ulna is safe procedure with few complications, produces excellent to good results.

Risk factors for revision surgery in operative treatment of traumatic injuries of the olecranon and prepatellar bursa

IntroductionTraumatic lacerations of the prepatellar (PB) and olecranon bursa (OB) are common injuries. The aim of this study was to gain descriptive data and to identify risk factors associated with complications that made revision surgery after primary bursectomy necessary.Material and methodsIn this retrospective monocentric study at a level I trauma center, all patients with traumatic lacerations of the PB or OB who were treated with primary surgical bursectomy from 2015 to 2020 were analyzed.Results150 consecutive patients were included. In 44% of cases, the PB was affected (n = 66), in 56% the OB (n = 84). The reoperation rate after surgical bursectomy was 10.7% (n = 16). The main cause of reoperation was wound infection (50%; n = 8). The most common pathogen of postoperative infections was Staphylococcus aureus (87.5%). Several comorbidities have been identified as risk factors for reoperation after primary surgical bursectomy, such as heart diseases, arterial hypertension, the use of antihypertensives and anticoagulation. In contrast, surgical expertise, use of drains, postoperative immobilization, and postoperative antibiotics had no statistically significant effect. A significantly higher postoperative infection rate (17.6%) was observed in patients who were operated more than 48 h after initial trauma.ConclusionsGiven the limited recommendations for therapy of these common injuries, further investigations should focus on standardized therapeutic options for lacerations of the PB or OB. Delayed surgical interventions after trauma were associated with higher complication rates. Therefore, urgent surgery within 48 h after trauma may help to prevent revisions.Level of evidenceLevel of evidence IV.

Traumatic elbow bursitis after professional MMA bouts: a case series

Professional mixed martial art (MMA) is a popular combat sport with a high incidence of orthopedic injuries. Traumatic elbow (olecranon) bursitis (TOB) while a common sport injury has not been well reported in combat sports medical literature. In this case series 4 MMA combatants with TOB are described. The mechanism of injury, clinical presentation and management cage side is discussed with the goal of improving care coordination between ringside and orthopedic physicians to help improve outcomes.

Evidence-Based Treatment and Differential Diagnoses of Olecranon Bursitis

Evidence-Based Treatment and Differential Diagnoses of Olecranon Bursitis Abstract. Bursitis olecrani is a common clinical diagnosis that can have systemic, infectious and traumatic causes. In this article we want to present the diagnostics, possible differential diagnoses, complications and the current therapy recommendations as a practical guide.

Diagnostic imaging and hematological and cytological analyses play a vital role in clinical investigation and selection of therapeutic approaches in a polo pony with septic olecranon bursitis

Diagnostic imaging and hematological and cytological analyses play a vital role in clinical investigation and selection of therapeutic approaches in a polo pony with septic olecranon bursitis

Hot off the press: SGEM #358-I would do anything for septic olecranon bursitis but I won't tap that.

Suspected septic olecranon bursitis is a common complaint in emergency medicine. Limited evidence exists as to the safety and necessity of bursal aspiration compared to empiric antibiotic therapy without aspiration. In this article, we summarize a study by Beyde et al. investigating these strategies, as well as the podcast and discussion, along with social media commentary.

The utility of routine cultures, cell count, and crystal evaluation of aspirate from aseptic olecranon bursitis.

BackgroundAspiration of the olecranon bursa is a treatment option for acute olecranon bursitis (OB). Typically, the aspirate is sent for microbiologic analysis, cell count, and crystal analysis. This study investigates the utility of fluid aspirate analysis from patients with clinically diagnosed aseptic OB.MethodsIn this prospective study (IRB #i20-00986), patients presenting with acute aseptic OB were treated with aspiration as standard of care. Patients consented to participate in this study via phone. Patients with suspected infectious bursitis, open draining wound, and chronic OB were excluded. The aspirate was sent out for routine microbiologic analysis (aerobic and anaerobic cultures and Gram staining) and fluid analyses, including cell count with differential and crystal analysis. Nucleated and differential cell count was reported as absolute numbers per cubic millimeter and percentage, respectively. Compression wrap was applied after OB aspiration, and patients were asked to ice and take anti-inflammatory medications. Clinical follow-up was done after 6 weeks and at 3 months for resolution vs. recurrence of symptoms, and the mean time to resolution was reported.ResultsA total of 26 patients (28 cases) with aseptic OB were enrolled in this study. Two patients had bilateral OB. The mean time to aspiration after the onset of symptoms was 26.4 days. One patient had recurrence of swelling after the first aspiration and underwent repeat bursa aspiration. No organisms were isolated or reported on Gram staining on any of the aspirate samples. Two aspirates were reported positive for calcium pyrophosphate dihydrate crystals. No patient had monosodium urate crystals. All patients had resolution of swelling and symptoms without the development of postaspiration infection.ConclusionsThis study demonstrates limited clinical utility of routine microbiologic analysis (cell count, microbiologic, and crystal evaluation) of fluid aspirate from clinically diagnosed aseptic OB. Although 7% of fluid aspirates were positive for calcium pyrophosphate dihydrate crystals, it did not change the overall treatment.

Hyperkalemia with Mineralocorticoid Receptor Antagonist Use in People with CKD: Understanding and Mitigating the Risks.

<i>Background:</i> The superficial location of the olecranon bursa places it at high risk for injury, possibly leading to the entry of bacteria into the bursal sac. Early differentiation between septic and nonseptic olecranon bursitis is paramount to direct therapy, to hasten recovery, and to prevent chronic inflammation. <i>Methods:</i> A literature review was performed using MEDLINE files from 1967 to the present. Additional references from the bibliographies of these were also utilized. <i>Results and Conclusions:</i> Olecranon bursitis is a common condition that requires the treating physician to be aware of the predisposing factors, clinical signs and symptoms, and laboratory findings of both septic and nonseptic olecranon bursitis. With early recognition, prompt therapy, and preventive measures, the morbidity of septic olecranon bursitis can be considerably reduced, but surgical incision and drainage or excision could be required if conservative therapy fails.

18S and ITS2 rDNA sequence-structure phylogeny of Prototheca (Chlorophyta, Trebouxiophyceae)

Protothecosis is an infectious disease caused by organisms currently classified within the green algal genus Prototheca. The disease can manifest as cutaneous lesions, olecranon bursitis or disseminated or systemic infections in both immunocompetent and immunosuppressed patients. Concerning diagnostics, taxonomic validity is important. Prototheca, closely related to the Chlorella species complex, is known to be polyphyletic, branching with Auxenochlorella and Helicosporidium. The phylogeny of Prototheca was discussed and revisited several times in the last decade; new species have been described. Phylogenetic analyses were performed using ribosomal DNA (rDNA) and partial mitochondrial cytochrome b (cytb) sequence data. In this work we use Internal Transcribed Spacer 2 (ITS2) as well as 18S rDNA data. However, for the first time, we reconstruct phylogenetic relationships of Prototheca using primary sequence and RNA secondary structure information simultaneously, a concept shown to increase robustness and accuracy of phylogenetic tree estimation. Using encoded sequence-structure data, Neighbor-Joining, Maximum-Parsimony and Maximum-Likelihood methods yielded well-supported trees in agreement with other trees calculated on rDNA; but differ in several aspects from trees using cytb as a phylogenetic marker. ITS2 secondary structures of Prototheca sequences are in agreement with the well-known common core structure of eukaryotes but show unusual differences in their helix lengths. An elongation of the fourth helix of some species seems to have occurred independently in the course of evolution.

Efficacy of empiric antibiotic management of septic olecranon bursitis without bursal aspiration in emergency department patients.

ObjectivesMany guidelines for septic olecranon bursitis recommend aspiration of the bursa prior to initiation of antimicrobial therapy despite the absence of robust clinical data to support this practice and known risk of aspiration complications. Our objective was to describe outcomes associated with empiric antibiotic therapy without bursal aspiration among emergency department (ED) patients with suspected septic olecranon bursitis.MethodsWe conducted a retrospective observational cohort study of patients presenting to an academic ED from January 1, 2011, to December 31, 2018, with olecranon bursitis. The health record was reviewed to assess patient characteristics and outcomes within 6 months of the ED visit. Olecranon bursitis was considered “suspected septic” if the patient was treated with antibiotics. The primary outcome of interest was complicated versus uncomplicated bursitis resolution. Uncomplicated resolution was defined as bursitis resolution without subsequent bursal aspiration, surgery, or hospitalization.ResultsDuring the study period, 264 ED patients were evaluated for 266 cases of olecranon bursitis. The median age was 57 years and 85% were men. Four (1.5%) patients had bursal aspiration during their ED visit, 39 (14.7%) were admitted to the hospital, 76 (28.6%) were dismissed without antibiotic therapy, and 147 (55.3%) were dismissed with empiric antibiotic therapy for suspected septic olecranon bursitis. Among these 147 patients, 134 had follow‐up available including 118 (88.1%, 95% confidence interval [CI] = 81.1%–92.8%) with an uncomplicated resolution, eight (6.0%, 95% CI = 2.8%–11.8%) who underwent subsequent bursal aspiration, and nine (6.7%, 95% CI = 3.3%–12.7%) who were subsequently admitted for inpatient antibiotics.ConclusionsEighty‐eight percent of ED patients with suspected septic olecranon bursitis treated with empiric antibiotics without aspiration had resolution without need for subsequent bursal aspiration, hospitalization, or surgery. Our findings suggest that empiric antibiotics without bursal aspiration may be a reasonable initial approach to ED management of select patients with suspected septic olecranon bursitis.

Bursites infectieuses

Olecranon and prepatellar septic bursitis are a common medical problem. However, evidence regarding the management of septic bursitis is limited and no recommendations have been published. Previous studies showed considerable variability in treatment practices, the data available being mainly from retrospective series. The objective of the review was to synthesize the published data about the diagnosis and management of olecranon and patellar septic bursitis.

Tenosynovitis in a renal transplant recipient: Making the diagnosis firsthand

A 63-year-old man presented with 2 months of right upper extremity (RUE) redness and swelling 17 months after deceased donor renal transplant. He underwent hemodialysis for hypertension-induced renal failure for 3 years pretransplant via a left upper extremity radiocephalic arteriovenous fistula. Although not sensitized pretransplant, he received thymoglobulin induction for anticipated delayed graft function. Allograft function did not recover. He remained on dialysis and relisted for transplantation, while maintained on tacrolimus, mycophenolic acid, and prednisone. Two months before presentation, he noted gradual swelling involving his right hand second and fourth digits. This progressed to involve the right palm, wrist, and elbow with associated pain and erythema. He denied RUE trauma, fever, or systemic symptoms. He denied exposures to animals, gardening, caves, freshwater bodies, or construction sites. He lived in North Carolina with no travel outside the region. Examination revealed erythematous, tender, and fluctuant nodules involving the right wrist and palm, second and fourth digit dactylitis (Figure 1), and right olecranon bursitis. RUE joint range of motion was intact. His examination was otherwise unremarkable. Laboratory data: white blood cell count 1300 cells/mm3 (neutrophils 1058 cells/mm3, lymphocytes 138 cells/mm3), hemoglobin 7.6 g/dl, platelets 176 000/µl, and normal liver functions. RUE magnetic resonance imaging (MRI) demonstrated full-thickness soft tissue edema with large nodular areas of heterogeneous signal abnormality correlating with his examination, without abscess or osteomyelitis. Hypothenar eminence skin biopsy demonstrated extensive dermal and subcutaneous tissue necrosis (Figure 2). Periodic-acid Schiff stain and cultures from the olecranon bursa fluid aspirate and skin biopsy showed Histoplasma capsulatum. 1How do most transplant recipients acquire histoplasmosis?aEnvironmental fresh water exposurebInhalation of airborne sporescPerson to person transmissiondTransmission through an animal biteeTransmission via the donor allograft2Which study is most likely to reveal an additional site of infection in this case?aBone marrow biopsybEchocardiographycChest computed tomography (CT)dMRI braineMRI spine3Which clinical feature supports tenosynovitis with concomitant deeper soft tissue infection of the wrist and hand?aConcomitant olecranon bursitisbDactylitis with intact joint range of motioncLack of discrete abscess formation on imagingdSubacute progression of clinical findingseSubcutaneous tissue necrosis on skin biopsy4Despite discontinuing immunosuppression and administering liposomal amphotericin B (AMB) for 3 weeks, the patient’s right-hand abnormalities failed to demonstrate significant clinical improvement. What is the best next step in the management of this patient’s infection?aContinue with liposomal AMB to allow more time for a clinical responsebAdd an azole antifungal agent to the treatment regimencAdd empiric antibacterial coverage for possible superinfectiondAdminister high dose steroids to treat immune reconstitution syndromeePerform surgical exploration and debridement

Ultrasound-Guided Doxycycline Injection for Aseptic Olecranon Bursitis: Case Report

BACKGROUND: This case report describes the use of ultrasound-guided doxycycline injection as sclerotherapy for the treatment of aseptic olecranon bursitis. CASE REPORT: Our patient presented with a several-week history of posterior elbow swelling and tenderness. The clinical picture was consistent with aseptic olecranon bursitis. Ultrasonography was used to visualize posterior elbow structures and provide needle guidance to aspirate the fluid within the olecranon bursa and inject a sclerosant, doxycycline. The patient’s recovery was uneventful, and the bursitis did not recur. CONCLUSION: There are no other case reports describing ultrasound-guided injection of a sclerosant for treatment of aseptic olecranon bursitis. Doxycycline is an effective and safe sclerosant that can be considered for the treatment of aseptic olecranon bursitis. KEY WORDS: Olecranon bursitis, doxycycline, sclerotherapy, ultrasonography, injections, elbow

A Soccer Fan’s Pain In The Elbow

HISTORY: A 35-year-old right-hand dominant male soccer fan presents with 3 days of acute right elbow pain. He began to experience progressive right lateral elbow pain while clapping exuberantly during a Seattle Sounders come from behind victory. He could recall no other trauma or inciting event. He had noticed some mild elbow soreness a few days preceding acute onset of pain. He endorsed elbow warmth and swelling as well as severe pain with any movement. He denied numbness, tingling, chills, fevers, fatigue, malaise. No prior history of rheumatic disease or gout. An x-ray obtained prior to presentation to our clinic showed small elbow joint effusion which the radiologist noted was suspicious for occult radial head fracture. PHYSICAL EXAMINATION: Swelling of right elbow with mild erythema. Decreased passive and active range of motion with elbow flexion, elbow extension, pronation, and supination. Tenderness to palpation overlying radial head as well as to olecranon bursa. Resisted wrist extension reproduced symptoms. Neurovascular exam was normal. DIFFERENTIAL DIAGNOSIS: 1. Occult radial head fracture 2. Lateral epicondylitis 3. Radial tunnel syndrome 4. Septic arthritis 5. Inflammatory arthropathy TEST AND RESULTS: X-ray: A small joint effusion suspicious for occult radial head fracture was noted. Ultrasound: Large elbow joint effusion tracking from the radiocapitellar joint deep to the triceps tendon insertion posteriorly. Common extensor tendon was intact. No swelling of the radial nerve visualized. Joint Aspiration: Joint aspiration revealed initially bloody then cloudy fluid. No organisms on gram stain or culture. Cell count revealed inflammatory joint aspirate containing over 50,000 WBCs of which 95% were neutrophils. Intracellular monosodium urate crystals were identified. FINAL WORKING DIAGNOSIS: Acute gout flare of right elbow TREATMENT AND OUTCOMES: Radiocapitellar joint steroid injection was performed due to ongoing pain despite oral NSAID use. Elbow pain resolved approximately 1 week after the injection. Dietary considerations were discussed. Patient advised to discuss uric acid lowering agents with PCP.

Clinical characteristics and management of olecranon and prepatellar septic bursitis in a multicentre study.

No current guidelines are available for managing septic bursitis (SB). To describe the clinical characteristics and management of olecranon and prepatellar SB in five French tertiary care centres. This is a retrospective observational multicentre study. SB was diagnosed on the basis of positive cultures of bursal aspirate. In the absence of positive bursal fluid, the diagnosis came from typical clinical presentation, exclusion of other causes of bursitis and favourable response to antibiotic therapy. We included 272 patients (median age of 53 years, 85.3% male and 22.8% with at least one comorbidity). A microorganism was identified in 184 patients (67.6%), from bursal fluids in all but 4. We identified staphylococci in 135 samples (73.4%), streptococci in 35 (19%) and 10 (5.5%) were polymicrobial, while 43/223 bursal samples remained sterile (19.3%). Forty-nine patients (18%) were managed without bursal fluid analysis. Antibiotic treatment was initially administered IV in 41% and this route was preferred in case of fever (P = 0.003) or extensive cellulitis (P = 0.002). Seventy-one (26%) patients were treated surgically. A low failure rate was observed (n = 16/272, 5.9%) and failures were more frequent when the antibiotic therapy lasted <14 days (P = 0.02) in both surgically and medically treated patients. Despite variable treatments, SB resolved in the majority of cases even when the treatment was exclusively medical. The success rate was equivalent in the non-surgical and the surgical management groups. However, a treatment duration of <14 days may require special attention in both groups.

Lipoma in olecranon bursa: A case report

We report a case of a 55-year-old male patient who presented with swelling over his right elbow of 5-year duration. An ultrasound examination revealed an echogenic mass within the olecranon bursa. On magnetic resonance imaging, the mass revealed the signal intensity of fat, and it was attached to the bursal lining by means of a pedicle. There was no restriction on diffusion-weighted images and no significant contrast enhancement. Excision was performed under local anesthesia. The excised specimen revealed mature fat cells on histopathology.

Endoscopic Decompression of Olecranon Tophus

The olecranon bursa is very commonly involved in tophaceous gout because of the tendency of monosodium urate crystals to deposit in superficial structures with low temperatures. Surgery is indicated if the olecranon tophus is recalcitrant to medical treatment. Open surgery requires a long incision over the tophus and may lead to wound complications. Endoscopic debridement of the tophus can reduce the risk of wound complications. In this Technical Note, the technical details of endoscopic decompression of an olecranon tophus are described. This endoscopic technique also allows debridement of tophus infiltration of the triceps tendon.

Unplanned Return to the Operating Room in Upper-Extremity Surgery: Incidence and Reason for Return

Complications after upper-extremity surgery are generally infrequent. The purpose of this study was to assess the rate of early unplanned return to the operating room (URTO) within 3 months after surgery) in upper-extremity surgical procedures. Our hypotheses were that the rate of URTO in upper-extremity surgery would be low and that surgically treated fractures would be at greatest risk for complications. We performed a retrospective review of all upper-extremity surgical procedures performed at a large academic practice of fellowship-trained hand surgeons over a 5-year period. A chart review was conducted of all patients who underwent a second surgery within 3 months of the initial surgery. The surgical billing database was queried to determine the incidence of URTO per Current Procedural Terminology code. There were 422 Current Procedural Terminology codes with URTO out of a total of 62,608, for an incidence of 0.6%. The most frequently performed procedures were carpal tunnel release (10,674; 0.1% URTO), trigger finger release (4,549; 0.5% URTO), and open reduction internal fixation (ORIF) for distal radius fracture (2,728; 1.2% URTO). Procedures with the highest incidences of URTO were open reduction and internal fixation of the ulna (4.9%) and excision of the olecranon bursa (4.1%). Traumatic injuries were more commonly associated with URTO compared with elective procedures. Bony trauma and soft tissue trauma had URTO incidences of 1.4% and 1.1%, respectively, whereas bony elective and soft tissue elective cases were 0.6% and 0.4%, respectively. The 90-day URTO rate after upper-extremity surgery was low but higher than previously reported 30-day reoperation rates. Elbow procedures were most likely to result in URTO, as were procedures relating to bony and soft tissue trauma. Based on these results, we are able to counsel patients that the most common procedures we perform have low URTO rates, but surgically treated fractures are at greatest risk. Prognostic II.

Methicillin Susceptible Staphylococcus aureus is the predominant Organism in Septic Bursitis with the Majority Involving the Olecranon Bursa: A Study of 65 Cases

Bursae are fluid filled structures between mobile parts of the musculoskeletal system to reduce friction by lubrication. Repeated trauma to bursae results in bursitis which are usually aseptic initially, which may be followed by infection. Many cases are related to occupational or recreational activities. We present an analysis of cases of Staphylococcus aureus septic bursitis admitted to 10 hospitals over a 3-year period. The olecranon bursa was the most common site involved 42/65 (64.6%) followed by prepatellar bursa 17/65 (26.1%). The mean age was 61.2 years. Fifty five out of Sixty-five (84.6%) were male. The majority were caused by methicillin susceptible Staphylococcus aureus 52/65 (80%). The occupational history was missing for most patients. The occupations reported in few of the patient charts were floor worker, construction worker and roofer. Sixty one out of sixty-five (92.4%) of cases involved the elbow and knee. Avoidance of activities that result in repeated friction or trauma to elbows and knees would prevent majority of cases of septic bursitis.

Management of septic and aseptic prepatellar bursitis: a systematic review.

Despite contributing to significant morbidity in working-age adults, there is no consensus on the optimal treatment for prepatellar bursitis. Much of the existing literature combines prepatellar and olecranon bursitis. This systematic review aims to determine the optimal management of prepatellar bursitis. A primary search of electronic published and unpublished literature databases from inception to November 2019 was completed. Articles over 25years old, case reports with less than four patients, paediatric studies, and non-English language papers were excluded. Our primary outcome was recurrence after 1year. Comparisons included endoscopic vs open bursectomy, duration of antibiotics. Methodological quality was assessed using the Institute of Health Economics and Revised Cochrane Risk of Bias scoring systems. Meta-analyses were conducted where appropriate. In total 10 studies were included (N = 702). Endoscopic and open bursectomy showed no difference in recurrence after 1year (OR 0.41, 95% CI 0.05-3.53, p = 0.67), and surgical complications (OR 1.44, 95% CI 0.34-6.08, p = 0.44). 80% endoscopically-treated patients were pain free after 1year. Patients treated with antibiotics for less than 8days were not significantly more prone to recurrence (2/17 vs 10/114, OR 0.66, 95% CI 0.13-3.29, p = 0.64) compared to 8days plus at minimum 1year post injury. Our study represents the largest cohort of patients evaluating management strategies for prepatellar bursitis, and includes data not previously published. Endoscopic bursectomy is non-inferior to open bursectomy, enabling a shorter hospital stay. It also offers a relatively low risk of post-operative pain. Endoscopic bursectomy is a viable option to treat both septic and aseptic prepatellar bursitis. Our small cohort suggests recurrence and hospital stay are not improved with antibiotic treatment exceeding 7days for septic prepatellar bursitis.