Correct diagnosis and treatment of septic arthritis (SA) are essential to achieve satisfactory results and avoid lifelong consequences. Diagnosing septic arthritis is not always easy, which is why new biomarkers have been sought. Another difficulty in diagnosis is the increase in septic arthritis due to Kingella Kingae, which does not show the same signs and symptoms as classic Staphylococcus aureus infections. Increasingly, magnetic resonance imaging plays a more fundamental role in diagnosing septic arthritis, and many studies are focused on this line, especially for the study of associated pathologies. Numerous studies have been published on less invasive treatments for septic arthritis, although the evidence suggests that the results should be taken cautiously. Although most of the published studies focus on the hip and knee, there have also been recent publications on SA in the upper limb, foot, and ankle. Finally, the literature also pays attention to SA in young children due to its different etiology and the greater difficulties in its diagnosis.

In septic arthritis, joint lavage can be performed using arthrocentesis (articular needle aspiration) or arthrotomy. The use of fluoroscopy to guide the puncture involves radiation. Ultrasound (US) guidance is still little recommended to guide the treatment of septic arthritis in children. We wanted to know whether treating septic arthritis in children was feasible and safe under ultrasound (US) guidance.

We retrospectively included 67 children (mean age, 3.0 years; range: 1 month-12 years) treated for septic arthritis of the hip, shoulder, or ankle using arthrocentesis or arthrotomy under US or fluoroscopic guidance (non-US group) with at least two years of follow-up.

We found no significant difference between the groups. After arthrocentesis, patients in the US group remained in hospital for 0.8 days longer than those in the non-US group, but the difference was not significant. After arthrotomy, the arthrotomy-US group required 0.4 more days of hospitalization than the non-US group, but the difference was not significant. Patients in the US group exhibited higher initial CRP and WBC values than patients treated without US, although the differences were not significant. The WBC values of the arthrocentesis-US groups were higher than those of the non-US groups initially and at 72 h, but non significantly so; they became similar on day 5. Three puncture failures required arthrotomy (two under US guidance). Three patients required early revision surgery: one had undergone arthrocentesis with US, one arthrocentesis without US, and one arthrotomy without US. At the last follow-up, there were no clinical sequelae but two hip arthrotomies (one US and one non-US child) showed asymptomatic calcifications.

US guidance is feasible and safe for treating septic arthritis in children, visualizing structures not shown by X-rays and avoiding radiation exposure during surgery.

IV (case series).

IRB-MTP_2021_05_202100781.

BACKGROUND Clostridium cadaveris is a motile, anaerobic, gram-positive, spore-forming bacillus usually found in soil. However, rare cases of opportunistic infections have been documented in immunosuppressed individuals. This report details the case of an immunocompetent young patient who developed septic arthritis of the knee after a traumatic injury involving a rusty nail. The aim of this paper is to provide a comprehensive literature review, shed light on the potential occurrence of Clostridium cadaveris septic arthritis, and explore its management. CASE REPORT A young patient with no medical history presented a traumatic inoculation leading to septic arthritis on a native knee by Clostridium cadaveris. The patient underwent 2 surgical debridements after an initial bad evolution under probabilistic antibiotic therapy. Bacteriological long-growing cultures and antibiotic testing were employed to guide antibiotic therapy selection. The patient had a favorable clinical outcome with no residual knee complications, with laboratory results showed good evolution. A review of the literature showed that Clostridium cadaveris septic arthritis in immunocompetent patients is very rare. The management and subsequent results emphasize the potential impact of the initial emergency room treatment on patient outcomes, especially concerning seemingly benign traumas. CONCLUSIONS This case report highlights the necessity of rapid diagnosis of the cause of septic arthritis, particularly in children, to prevent joint and tissue damage, and the rare diagnosis of knee arthritis with Clostridium cadaveris. This report expands understanding of osteoarticular infections and enhances the need for rapid diagnosis and early treatment, when managing cases with atypical presentations.

Septic arthritis is one potential cause of pediatric joint effusion and pain that may lead to significant morbidity. We present a case where point-of-care ultrasound was used to identify and aspirate a joint effusion in a pediatric patient with septic arthritis of the ankle, facilitating timely diagnosis and care. We review the technique for arthrocentesis of the ankle and literature on point-of-care ultrasound in the diagnosis of pediatric septic arthritis.

Knee osteoarthritis is a challenging problem affecting many adults around the world. There are currently no medications that cure knee osteoarthritis. The only way to control the progression of knee osteoarthritis is early detection. Currently, X-ray imaging is a central technique used for the prediction of osteoarthritis. However, the manual X-ray technique is prone to errors due to the lack of expertise of radiologists. Recent studies have described the use of automated systems based on machine learning for the effective prediction of osteoarthritis from X-ray images. However, most of these techniques still need to achieve higher predictive accuracy to detect osteoarthritis at an early stage. This paper suggests a method with higher predictive accuracy that can be employed in the real world for the early detection of knee osteoarthritis. In this paper, we suggest the use of transfer learning models based on sequential convolutional neural networks (CNNs), Visual Geometry Group 16 (VGG-16), and Residual Neural Network 50 (ResNet-50) for the early detection of osteoarthritis from knee X-ray images. In our analysis, we found that all the suggested models achieved a higher level of predictive accuracy, greater than 90%, in detecting osteoarthritis. However, the best-performing model was the pretrained VGG-16 model, which achieved a training accuracy of 99% and a testing accuracy of 92%.

Acute septic arthritis in children is an orthopaedic emergency. A delay in diagnosis and inappropriate treatment can result in devastating damage to the joint with lifelong disability as a consequence. The clinical presentation can be a diagnostic challenge, especially in young children. A recent systematic review showed that joint tenderness and fever are important signals of septic arthritis. Ultrasound is helpful in detecting the presence of a joint effusion. Plain radiographs may show bone changes but magnetic resonance imaging is the most reliable imaging study for detecting concomitant osteomyelitis. The diagnosis of acute septic arthritis is highly suggestive when pus is aspirated from the joint, in case of a positive culture or a positive gram stain of the joint fluid, or if there is a white blood-cell count in the joint fluid of more than 50000/mm3. Staphylococcus aureus is the most commonly cultured organism. Recent systematic reviews have identified the most effective drainage techniques, including needle aspiration, arthroscopy and arthrotomy, depending on the affected joint. After the drainage procedure it is important to monitor the clinical and laboratory outcomes. Additional drainage procedures may be necessary in select cases.

The treatment paradigm for osteoarticular infections (OAIs) has changed drastically over the past 80 years, from the advent of penicillin to the use of broad-spectrum antibiotics. Before these drugs, surgery was the only available treatment for OAIs; today, antibiotic therapy is considered the primary response to them. As a result, surgical treatment of OAIs is thus far more rarely indicated, sometimes even considered outdated and obsolete. However, long experience has taught us that many OAI contexts can still benefit from surgical management, constituting an essential complement to medical treatment. The present article seeks to contextualize this discussion by providing a chronological review of the surgical treatments used in cases of OAI and describing the quality of evidence supporting their rehabilitation in well-established situations.