Article

Septic arthritis of the wrist is a diagnostic and therapeutic emergency.
Synovectomy and lavage by arthrotomy is often followed by stiffness. The purpose
of this study was to evaluate the diagnostic and therapeutic contribution of
emergency arthroscopic synovectomy with intraarticular lavage. Nine patients were
operated on for wrist pathology with septic appearance. All had signs of local
inflammation, three showed locoregional inflammation, three were febrile. In one
patient several joints were involved. Seven patients presented with inflammatory
or degenerative arthritis. All patients underwent emergency surgery using
radiocarpal joint puncture, arthroscopic exploration, intraarticular lavage and
synovectomy at both the radiocarpal and midcarpal joints. The results were
evaluated by pain, Quick DASH, grip strength, and wrist range of motion. In three
cases, joint fluid appeared clear, in three it was turbid, and in three purulent.
Gram stain and culture revealed bacteria in four cases. Synovitis was radiocarpal
four times, radiocarpal and midcarpal once. In one case, there was radiocarpal
and midcarpal chondritis. Average pain was 5.3/10 preoperatively and 2/10 at the
last clinical follow-up visit. Mean grip strength was 23.3 kg on the involved
side vs. 33.5 kg on the opposite one. Mean flexion was 55 degrees for the
involved wrist vs. 68 degrees ; mean extension was 52 degrees for the affected
wrist vs. 59 degrees . No patient was reoperated on. In all cases, there was no
sign of local inflammation, regional lymphadenopathy or systemic infection at the
last follow-up. One patient died of colon metastatic cancer. Another patient
developed a severe Complex Regional Pain Syndrome type I (CRPS1). Our results
suggest three principles of management of wrist arthritis with septic appearance:
extended surgical indication, emergency operation and arthroscopic procedure.
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Langue : ANGLAIS