Septic arthritis following joint injections: a 17 years retrospective study in an Academic General Hospital.

BACKGROUND: Septic arthritis following intra-articular infiltrations is an uncommon devastating complication correlated  to high costs for the health service and often to poor outcomes. The purpose of this study is to assess a 17-years experience in a single academic multispecialist hospital managing this uncommon complication in Orthopaedic practice. METHODS: Patients with diagnosis of septic arthritis following joint injections treated in our hospital from January 2002 to December 2019 were included in the study. Clinical and demographic data, pathogens, injected agent, conservative/surgical treatments were reviewed. Patient were classified according to the ore operative Charlson Comorbidity Index (CCI) and the Cierny-Mader Classification(CMC). Furthermore follow-up outcome and time occurred to infection eradication were registered. RESULTS: We included in the study 11 patients with a median age of 74 years old (IQR= 61.5 - 79). The median CCI was 3  (IQR= 2 - 5) and the majority of patients belong to CMC = B class. Septic arthritis occurred mainly following corticosteroids injections and more frequently involving knees. The pathogen more often isolated was Staphylococcus aureus. Five (45%) patients referred an history of multiple intrarticular injections. 7 patients (64%) had a complete resolution following an arthroscopic debridement, 4 (36%) patients underwent to a 2-stage replacement and one of them hesitated in an arthrodesis because of a recurrent periprothesic joint infection and extensor apparatus insufficiency. CONCLUSION: The authors observed a potential increased risk of septic arthritis following joint injection in patients with history of multiple injections and poor health/immunological conditions. They recommend an early arthroscopic debridement as the treatment of choice especially in septic knees  performed in a multispecialist dedicated center.

Case series of traumatic neglected Extensor Hallucis Longus lacerations: choice of surgical treatment based on injury type.

BACKGROUND AND AIM: Extensor Hallucis Longus (EHL) tendon rupture is a rare injury of the foot, representing only 1% of overall tendon rupture. Early diagnosis and surgical repair are recommended but there is still no consensus regarding the ideal treatment. The purpose of this study was to evaluate a case series of patients with neglected extensor hallucis longus (EHL) tendon rupture. METHODS: We report a case series of 3 patients affected by traumatic neglected EHL lacerations treated with reconstructive surgery using tissue scaffolds, between November 2019 and May 2020. Demographics data, mechanism of injury, zone of injury, tendon gap, time to surgery, type of surgical repair, preoperative and postoperative functional score were collected with a minimum follow-up of 8 months. RESULTS: The zone of injury (according to Al-Qattan classification) involved was in 1 case zone 2, in 1 case zone 4 and in the last case zone 5. The mean value of intraoperative tendon gap was of 3,4 cm. The elapsed time from injury to surgery was an average of 3,3 months. One tendon transfer surgery and two primary repairs with Krakow fashion were performed, all augmented with tissue scaffolds. The mean preoperative and postoperative American Orthopedic Foot and Ankle Society (AOFAS) scores were, respectively, 43 and 97. CONCLUSIONS: Our results highlight good functional result and satisfaction with active extension of the hallux restored in all patients. According to our experience, we recommend choosing reconstruction technique basing on the topographic zone of lesion and intraoperative tendon gap.