22

Wrist septic arthritis with DRUJ involvement treated with arthroscopic debridement and continuous catheter irrigation - A case report

Wrist septic arthritis with involvement of DRUJ is rare. We have been using minimal invasive technique with continuous catheter irrigation to treat close space hand infection and we have adapted the concept to management septic wrist. We report one case who was treated successfully with arthroscopic debridement and continuous catheter irrigation.

We report a case of 63 years old male. He presented with 5 days of left wrist pain associated with high fever up t0 40 degrees. On examination his wrist was remarkably swollen, warm, red and tender. The motion is very limited with significant pain. Investigation showed raised total white blood cell count (13.8 x109/L), CRP 238 mg/L and procalcitonin 6.6 μg/L. X-ray showed chronic scapholunate dissociation with arthritic changes. Joint aspiration revealed frank pus. We preform urgent surgery in emergency operating theatre. We debrided the radiocarpal joint via 3,4 and 6R portals, and midcarpal joint via MCR and MCU portals under wrist arthroscope, and inserted 6Fr infant feeding catheter into each joint space via the portals respectively. There was large amount of pus and synovitis noted intra-operatively. Post-operatively, the continuous irrigation was controlled by infusion pumps to maintain 5ml/hr rate via each catheter. On post-operative day 1, he was found to have significant relief of midcarpal and radiocarpal joint tenderness. However there was still significant tenderness over DRUJ and he experienced remarkable pain on pronation/supination. He was then brought back to operating theatre for relook debridement with arthroscope assistance. Intra-operatively, we found a central perforation over TFCC with pus pouring from DRUJ. We further perform DRUJ debridement via direct foveal and DRUJ portals and inserted additional irrigation catheter into DRUJ. All wounds were closed primarily. A subcutaneous drain was also inserted.

After 4 days of continuous irrigation, he regained pain free range of motion and all catheters and drain were removed. No further secondary debridement or closure was needed.

Arthroscopic debridement with continuous catheter irrigation is a reliable minimal invasive technique to treat wrist septic arthritis. Although DRUJ is not routinely inspected when treating wrist septic arthritis, careful examination with arthroscope should be done to look for possible DRUJ involvement so that it can be addressed accordingly.

septic arthritis, continuous catheter irrigation, arthroscopic debridement