Pediatrik dirsek septik artritinin sunumu ve tedavisi: Olgu serisi

Yıl 2020, Cilt: 4 Sayı: 11, 1063 - 1067, 01.11.2020

Bülent Kılıç Anıl Agar

https://doi.org/10.28982/josam.806401

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

Öz

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.

Anahtar Kelimeler

septic arthritis, elbow, septic joint, pediatric orthopaedics

Kaynakça

• 1. Rutz E. Septic arthritis of the hip joint in children is an emergency. Afr J Paediatr Surg. 2012 Jan-Apr;9(1):1-2. doi: 10.4103/0189-6725.93292. PMID: 22382095.
• 2. Arnold JC, Bradley JS. Osteoarticular Infections in Children. Infect Dis Clin North Am. 2015 Sep;29(3):557-74. doi: 10.1016/j.idc.2015.05.012. PMID: 26311358.
• 3. Baghdadi T, Saberi S, Sobhani Eraghi A, Arabzadeh A, Mardookhpour S. Late sequelae of hip septic arthritis in children. Acta Med Iran. 2012;50(7):463-7. PMID: 22930377.
• 4. Forlin E, Milani C. Sequelae of septic arthritis of the hip in children: a new classification and a review of 41 hips. J Pediatr Orthop. 2008 Jul-Aug;28(5):524-8. doi: 10.1097/BPO.0b013e31817bb079. PMID: 18580366.
• 5. Sukswai P, Kovitvanitcha D, Thumkunanon V, Chotpitayasunondh T, Sangtawesin V, Jeerathanyasakun Y. Acute hematogenous osteomyelitis and septic arthritis in children: clinical characteristics and outcomes study. J Med Assoc Thai. 2011 Aug;94 Suppl 3:S209-16. PMID: 22043778.
• 6. Ahmed H, Dix-Peek S, Martin N, Hoffman EB. Septic arthritis in children: a 20-year study. In: Orthopaedic Proceedings. The British Editorial Society of Bone & Joint Surgery, 2005. p. 279-279.
• 7. Kocher MS, Mandiga R, Zurakowski D, Barnewolt C, Kasser JR. Validation of a clinical prediction rule for the differentiation between septic arthritis and transient synovitis of the hip in children. J Bone Joint Surg Am. 2004 Aug;86(8):1629-35. doi: 10.2106/00004623-200408000-00005. PMID: 15292409.
• 8. Morrey BF, An KN, Chao EYS. Functional evaluation of the elbow. In: Morrey BF, editor. The elbow and its disorders. 2nd edition. Philadelphia: WB Saunders; 1993. pp. 86–89.
• 9. Desbiolles A, Carls F, Dube S, Hirsig J. Pronation douloureuse--Ein diagnostischer Reinfall bei eitriger Arthritis und Osteomyelitis des Ellbogens im Kleinkindesalter [Painful pronation--a diagnostic pitfall in septic arthritis and osteomyelitis of the elbow in infancy]. Z Kinderchir. 1987 Jun;42(3):187-9. German. doi: 10.1055/s-2008-1075582. PMID: 3617945.
• 10. Leslie BM, Harris JM 3rd, Driscoll D. Septic arthritis of the shoulder in adults. J Bone Joint Surg Am. 1989 Dec;71(10):1516-22. PMID: 2592392.
• 11. Mehta P, Schnall SB, Zalavras CG. Septic arthritis of the shoulder, elbow, and wrist. Clin Orthop Relat Res. 2006 Oct;451:42-5. doi: 10.1097/01.blo.0000229322.30169.29. PMID: 16906071.
• 12. Nduaguba AM, Flynn JM, Sankar WN. Septic Arthritis of the Elbow in Children: Clinical Presentation and Microbiological Profile. J Pediatr Orthop. 2016 Jan;36(1):75-9. doi: 10.1097/BPO.0000000000000390. PMID: 25575360.
• 13. Kennedy N, Chambers ST, Nolan I, Gallagher K, Werno A, Browne M, et al. Native Joint Septic Arthritis: Epidemiology, Clinical Features, and Microbiological Causes in a New Zealand Population. J Rheumatol. 2015 Dec;42(12):2392-7. doi: 10.3899/jrheum.150434. Epub 2015 Nov 1. PMID: 26523022.
• 14. Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M. Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991. Ann Rheum Dis. 1999 Apr;58(4):214-9. doi: 10.1136/ard.58.4.214. PMID: 10364899; PMCID: PMC1752863.
• 15. Fridkin SK, Hageman JC, Morrison M, Sanza LT, Como-Sabetti K, Jernigan JA, et al; Active Bacterial Core Surveillance Program of the Emerging Infections Program Network. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med. 2005 Apr 7;352(14):1436-44. doi: 10.1056/NEJMoa043252. Erratum in: N Engl J Med. 2005 Jun 2;352(22):2362. PMID: 15814879.
• 16. Bowakim J, Marti R, Curto A. Elbow septic arthritis in children: clinical presentation and management. J Pediatr Orthop B. 2010 May;19(3):281-4. doi: 10.1097/BPB.0b013e3283387d2d. PMID: 20300010.
• 17. Frank G, Mahoney HM, Eppes SC. Musculoskeletal infections in children. Pediatr Clin North Am. 2005 Aug;52(4):1083-106, ix. doi: 10.1016/j.pcl.2005.04.003. PMID: 16009258.
• 18. McCarthy JJ, Dormans JP, Kozin SH, Pizzutillo PD. Musculoskeletal infections in children: basic treatment principles and recent advancements. Instr Course Lect. 2005;54:515-28. PMID: 15948476.
• 19. Montgomery CO, Siegel E, Blasier RD, Suva LJ. Concurrent septic arthritis and osteomyelitis in children. J Pediatr Orthop. 2013 Jun;33(4):464-7. doi: 10.1097/BPO.0b013e318278484f. PMID: 23653039.
• 20. Lavy CB, Thyoka M. For how long should antibiotics be given in acute paediatric septic arthritis? A prospective audit of 96 cases. Trop Doct. 2007 Oct;37(4):195-7. doi: 10.1258/004947507782332775. PMID: 17988472.
• 21. Helito CP, Noffs GG, Pecora JR, Gobbi RG, Tirico LE, Lima AL, et al. Epidemiology of septic arthritis of the knee at Hospital das Clínicas, Universidade de São Paulo. Braz J Infect Dis. 2014 Jan-Feb;18(1):28-33. doi: 10.1016/j.bjid.2013.04.010. Epub 2013 Sep 9. PMID: 24029436.
• 22. Fabry G, Meire E. Septic arthritis of the hip in children: poor results after late and inadequate treatment. J Pediatr Orthop. 1983 Sep;3(4):461-6. doi: 10.1097/01241398-198309000-00008. PMID: 6630490.