Sunday, November 20, 2011

Septic, infectious arthritis of the shoulder - clear and present danger

A healthy man who fell from his roof a year ago. His midshaft  humeral fracture was fixed with a locking nail and the fracture healed uneventfully.
However his shoulder became stiff and did not respond to a manipulation. He was referred to us with a stiff painful shoulder, but no evidence of redness, fevers, chills or swelling. His CBC was normal. Here is an AP view of his shoulder.
At surgery there was a moderate chronic inflammation with bloody joint fluid. There were > 5 white cells per high power field on two frozen sections. Cultures are pending.

Lesson: This is not the expected course after a well-done fracture fixation. The complete destruction of the joint surface with cyst formation on the humeral head and glenoid and no osteophytes strongly suggests inflammatory arthritis.

Question: What did we do? What were the results of the cultures?

Stay tuned!


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