Pediatrik dirsek septik artritinin sunumu ve tedavisi: Olgu serisi

Öz

Amaç: Septik artrit acil bir ortopedik durumdur. Dirseğin septik artriti diğer eklemlere göre daha nadir görülmektedir. Bu çalışmanın amacı, dirsek septik artritinin klinik ve radyolojik belirleyicilerini değerlendirmek ve orta dönem klinik sonuçlarını gözden geçirmektir. Yöntemler: Ocak 2015-Ocak 2017 tarihleri arasında üçüncü basamak bir çocuk hastanesine başvuran ve septik artrit tanısı alan ve ardından drenaj ve debridman ile tedavi edilen hastalardan vaka serisi çalışması yapıldı. Tüm değerlendirmeler; hasta geçmişi, fiziksel muayene ve radyolojik ve laboratuvar incelemelerini içeriyordu. Laboratuvar testlerinde tam kan sayımı, eritrosit sedimantasyon hızı (ESR), C-reaktif protein (CRP) ve kan kültürü incelendi. Ayrıca hastaların son takiplerinde dirsek Mayo skorları da incelendi. Bulgular: Değerlendirme; yaş ortalaması 79 ay (2-161 ay) olan 3 erkek ve 2 kadın olmak üzere 5 hasta (5 dirsek) üzerinde yapıldı. Tüm hastalar ağrı, lokal inflamasyon belirtileri (şişlik, kızarıklık, ateş artışı) ve ateş (>38.5 °) ile başvurdu. Laboratuvar tetkiklerinde lökosit sayısı >11.000 olarak tanımlanan tüm hastalarda lökositoz tespit edildi ve tüm hastaların CRP ve ESR değerleri yüksekti. Hastanede yatış sırasında ortalama CRP düzeyi 110,2 (17,5-285) ve ortalama ESR düzeyi 46 (24-85) idi. Hastalar ortalama 47 ay (31-58 ay) takip edildi. Son takip muayenesinde, tüm hastaların Mayo Dirsek Performans Skoru ortalama 82.3 (79-85) idi ve iyi bir sonuç olarak değerlendirildi. Sonuç: Acil servise şiddetli dirsek fonksiyon kısıtlaması ile başvuran ateş, kızarıklık ve şişlik ile başvuran ve önemli travma öyküsü olmayan hastalarda septik artrit her zaman akılda tutulmalıdır. Başarılı klinik sonuçlar elde etmek için erken debridman, irigasyon ve antibiyotik kullanımı önemlidir.

Anahtar Kelimeler

• Septik artrit
• Dirsek
• Septik eklem
• Pediatrik ortopedi

Presentation and management of pediatric elbow septic arthritis: Case series

Abstract

Aim: Septic arthritis is an emergency orthopedic situation, and septic arthritis of the elbow is rarely seen. The aim of this study was to evaluate the clinical and radiological determinants of septic arthritis of the elbow and review the mid-term clinical results. Methods: A case-series study was conducted on patients who visited a tertiary pediatric hospital between January 2015-January 2017, were diagnosed with septic arthritis of the elbow, and treated with drainage and debridement. All evaluations included obtaining a thorough history, physical examination, and radiological and laboratory workup. In the laboratory tests, full blood count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and blood culture were examined. Mayo scores of the elbows were evaluated in the last follow-up visit. Results: Five patients (5 elbows) including 3 males and 2 females with a mean age of 79 months (2-161 months) were included in this case-series. All patients presented with pain, signs of local inflammation (swelling, redness, increased heat) and fever (>38.5°). All patients had leukocytosis (leukocyte count>11,000), along with elevated CRP and ESR levels. Their mean CRP value during hospitalization was 110.2 (range: 17.5-285) and the mean ESR level was 46 (range: 24-85). The patients were followed up for a mean of 47 months (range: 31-58 months). At the final follow-up examination, the mean Mayo Elbow Performance Score of all the patients was 82.3 (range: 79-85), which was considered a good outcome. Conclusion: Septic arthritis should always be kept in mind in patients presenting to the Emergency Department with severe elbow function restriction together with fever, redness, swelling and no significant trauma history. To obtain successful clinical results, early debridement, irrigation, antibiotics use are important.

Keywords

• septic arthritis
• elbow
• septic joint
• pediatric orthopaedics

Kaynakça

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