scholarly journals Aspiration or arthrotomy for paediatric septic arthritis of the shoulder and elbow: a systematic review

2021 ◽  
Vol 6 (8) ◽  
pp. 651-657
Author(s):  
Anne J. Spaans ◽  
C.M. (Lilian) Donders ◽  
J.H.J.M. (Gert) Bessems ◽  
Christiaan J.A. van Bergen
Keyword(s):  
Systematic Review ◽  
Septic Arthritis ◽  
Upper Extremity ◽  
Elbow Joint ◽  
Clinical Results ◽  
Scientific Quality ◽  
Knowing That ◽  
Additional Procedure ◽  
Effective Drainage ◽  
Drainage Technique

Upper extremity arthritis in children can be treated with joint aspiration, arthroscopy or arthrotomy, followed by antibiotics. The literature seems inconclusive with respect to the optimal drainage technique. Therefore, the objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the upper extremity in children. Two independent investigators systematically searched the electronic MEDLINE, EMBASE and Cochrane databases for original articles that reported outcomes of aspiration, arthroscopy or arthrotomy for septic arthritis of the paediatric shoulder or elbow. Outcome parameters were clinical improvement, need for repetitive surgery or drainage, and complications. Out of 2428 articles, seven studies with a total of 171 patients treated by aspiration or arthrotomy were included in the systematic review. Five studies reported on shoulder septic arthritis, one study on elbow septic arthritis, and one study on both joints. All studies were retrospective, except for one randomized prospective study. No difference was found between type of treatment and radiological or clinical outcomes. Aspiration of the shoulder or elbow joint required an additional procedure in 44% of patients, while arthrotomy required 12% additional procedures. Conclusion: Both aspiration and arthrotomy can achieve good clinical results in children with septic arthritis of the shoulder or elbow joint. However, the scientific quality of the included studies is low. It seems that the first procedure can be aspiration and washout and start of intravenous antibiotics, knowing that aspiration may have a higher risk of additional drainage procedures. Cite this article: EFORT Open Rev 2021;6:651-657. DOI: 10.1302/2058-5241.6.200122

A systematic review of the optimal drainage technique for septic hip arthritis in children

2021 ◽  
pp. 112070002198966
Author(s):  
Cornelia Maria Donders ◽  
Anne J Spaans ◽  
Johannes H J M Bessems ◽  
Christiaan J A van Bergen
Keyword(s):  
Systematic Review ◽  
Septic Arthritis ◽  
Clinical Outcomes ◽  
Meta Analysis ◽  
Paediatric Population ◽  
Scientific Quality ◽  
Comprehensive Overview ◽  
Hip Arthritis ◽  
Drainage Technique

Introduction: The hip is one of the most commonly affected joints in paediatric septic arthritis. Drainage can be performed using arthrocentesis (articular needle aspiration), arthroscopy or arthrotomy. The objective of this systematic review was to identify the most effective drainage technique for septic hip arthritis in the paediatric population. Materials and methods: The electronic MEDLINE, EMBASE and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the paediatric hip. Outcome parameters were additional drainage procedures, clinical outcomes and radiological sequelae. The quality of each of the included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) score. Results: Out of 2428 articles, 19 studies with a total of 406 hip joints were included in the systematic review. Additional arthroscopy or arthrotomy was performed in 15% of the hips treated with arthrocentesis, in 14% after arthroscopy and in 3% after arthrotomy. Inferior clinical outcomes and more radiological sequelae were seen in patients treated with an arthrotomy. A meta-analysis could not be performed due to the diversity and low quality of the studies (MINORS median 4 [range 2–15]). Conclusions: This systematic review gives a comprehensive overview of the available literature on treatment for septic hip arthritis in children. Arthrocentesis and arthroscopic procedures may have a higher risk of additional drainage procedures in comparison with arthrotomy. However, arthrotomy might be associated with inferior outcomes in the longer term. The included studies are diverse and the scientific quality is generally low.

Clinical Results After Arthroscopic Treatment for Septic Arthritis of the Elbow Joint

2014 ◽  
Vol 30 (6) ◽  
pp. 673-678 ◽  
Author(s):  
Jun-Gyu Moon ◽  
Sandeep Bilaris ◽  
Wong-Kyo Jeong ◽  
Jung-Hoon Kim
Keyword(s):  
Septic Arthritis ◽  
Elbow Joint ◽  
Clinical Results ◽  
Arthroscopic Treatment

scholarly journals Arthrocentesis, arthroscopy or arthrotomy for septic knee arthritis in children: a systematic review

2020 ◽  
pp. 1-7
Author(s):  
Cornelia M. Donders ◽  
Anne J. Spaans ◽  
Johannes H. J. M. Bessems ◽  
Christiaan J. A. van Bergen
Keyword(s):  
Systematic Review ◽  
Septic Arthritis ◽  
Meta Analysis ◽  
Treatment Strategies ◽  
Needle Aspiration ◽  
Scientific Quality ◽  
Knee Arthritis ◽  
Level Of Evidence ◽  
Septic Knee Arthritis

Purpose Septic knee arthritis in children can be treated by arthrocentesis (articular needle aspiration) with or without irrigation, arthroscopy or arthrotomy followed by antibiotics. The objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the knee in children. Methods The electronic PubMed, Embase and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the knee. The quality of all included studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO). Results Out of 2428 articles, 11 studies with a total of 279 knees were included in the systematic review. The quality of evidence was low (MINORS median 4 (2 to 7)). A meta-analysis could not be performed because of the diversity and low quality of the studies. In septic knee arthritis, additional drainage procedures were needed in 54 of 156 (35%) knees after arthrocentesis, in four of 96 (4%) after arthroscopy and in two of 12 (17%) after arthrotomy. Conclusion Included studies on treatment strategies for septic arthritis of the knee in children are diverse and the scientific quality is generally low. Knee arthroscopy might have a lower risk of additional drainage procedures as compared with arthrocentesis and arthrotomy, with acceptable clinical outcomes and no radiological sequelae. Level of evidence IV

Management of upper extremity aneurysms: a systematic review

2020 ◽  
Vol 39 (2) ◽  
Author(s):  
Salomé Kuntz ◽  
Anne Lejay ◽  
Yannick Georg ◽  
Fabien Thaveau ◽  
Nabil Chakfé
Keyword(s):  
Systematic Review ◽  
Upper Extremity

scholarly journals Test characteristics of history, examination and investigations in the evaluation for septic arthritis in the child presenting with acute non-traumatic limp. A systematic review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e038088
Author(s):  
Jacky Tu ◽  
Peter Gowdie ◽  
Julian Cassar ◽  
Simon Craig
Keyword(s):  
Systematic Review ◽  
Diagnostic Accuracy ◽  
Septic Arthritis ◽  
Quality Assessment ◽  
Likelihood Ratio ◽  
Risk Prediction ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Prediction Tools ◽  
Clinical Risk

BackgroundSeptic arthritis is an uncommon but potentially significant diagnosis to be considered when a child presents to the emergency department (ED) with non-traumatic limp. Our objective was to determine the diagnostic accuracy of clinical findings (history and examination) and investigation results (pathology tests and imaging) for the diagnosis of septic arthritis among children presenting with acute non-traumatic limp to the ED.MethodsSystematic review of the literature published between 1966 and June 2019 on MEDLINE and EMBASE databases. Studies were included if they evaluated children presenting with lower limb complaints and evaluated diagnostic performance of items from history, physical examination, laboratory testing or radiological examination. Data were independently extracted by two authors, and quality assessment was performed using the Quality Assessment Tool for Diagnostic Accuracy Studies 2 tool.Results18 studies were identified, and included 2672 children (560 with a final diagnosis of septic arthritis). There was substantial heterogeneity in inclusion criteria, study setting, definitions of specific variables and the gold standard used to confirm septic arthritis. Clinical and investigation findings were reported using varying definitions and cut-offs, and applied to differing study populations. Spectrum bias and poor-to-moderate study design quality limit their applicability to the ED setting.Single studies suggest that the presence of joint tenderness (n=189; positive likelihood ratio 11.4 (95% CI 5.9 to 22.0); negative likelihood ratio 0.2 (95% CI 0.0 to 1.2)) and joint effusion on ultrasound (n=127; positive likelihood ratio 8.4 (95% CI 4.1 to 17.1); negative likelihood ratio 0.2 (95% CI 0.1 to 0.3)) appear to be useful. Two promising clinical risk prediction tools were identified, however, their performance was notably lower when tested in external validation studies.DiscussionDifferentiating children with septic arthritis from non-emergent disorders of non-traumatic limp remains a key diagnostic challenge for emergency physicians. There is a need for prospectively derived and validated ED-based clinical risk prediction tools.

scholarly journals Elbow Joint Fatigue and Bench-Press Training

2014 ◽  
Vol 49 (3) ◽  
pp. 317-321 ◽  
Author(s):  
Yen-Po Huang ◽  
You-Li Chou ◽  
Feng-Chun Chen ◽  
Rong-Tyai Wang ◽  
Ming-Jer Huang ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Upper Extremity ◽  
Athletic Training ◽  
Cycle Time ◽  
Elbow Joint ◽  
Muscle Activation ◽  
Bench Press ◽  
Lateral Force ◽  
Joint Force ◽  
Muscle Strengthening

Context: Bench-press exercises are among the most common form of training exercise for the upper extremity because they yield a notable improvement in both muscle strength and muscle endurance. The literature contains various investigations into the effects of different bench-press positions on the degree of muscle activation. However, the effects of fatigue on the muscular performance and kinetics of the elbow joint are not understood fully. Objective: To investigate the effects of fatigue on the kinetics and myodynamic performance of the elbow joint in bench-press training. Design: Controlled laboratory study. Setting: Motion research laboratory. Patients or Other Participants: A total of 18 physically healthy male students (age = 19.6 ± 0.8 years, height = 168.7 ± 5.5 cm, mass = 69.6 ± 8.6 kg) participated in the investigation. All participants were right-hand dominant, and none had a history of upper extremity injuries or disorders. Intervention(s): Participants performed bench-press training until fatigued. Main Outcome Measure(s): Maximal possible number of repetitions, cycle time, myodynamic decline rate, elbow-joint force, and elbow-joint moment. Results: We observed a difference in cycle time in the initial (2.1 ± 0.42 seconds) and fatigue (2.58 ± 0.46 seconds) stages of the bench-press exercise (P = .04). As the participants fatigued, we observed an increase in the medial-lateral force (P = .03) and internal-external moment (P ≤ .04) acting on the elbow joint. Moreover, a reduction in the elbow muscle strength was observed in the elbow extension-flexion (P ≤ .003) and forearm supination-pronation (P ≤ .001) conditions. Conclusions: The results suggest that performing bench-press exercises to the point of fatigue increases elbow-joint loading and may further increase the risk of injury. Therefore, when clinicians design bench-press exercise regimens for general athletic training, muscle strengthening, or physical rehabilitation, they should control carefully the maximal number of repetitions.

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