TITLE:
Septic Arthritis: A Need to Strengthen the Referral Chain in a Developing Economy
AUTHORS:
Ikpeme A. Ikpeme, Ngim E. Ngim, Anthonia A. Ikpeme, Afiong O. Oku
KEYWORDS:
Septic Arthritis; Health Seeking Contact; Definitive Treatment; South-South Nigeria
JOURNAL NAME:
Open Journal of Orthopedics,
Vol.3 No.2,
June
7,
2013
ABSTRACT: Aim: This retrospective analysis documents the features and factors
that potentially affect outcomes in septic arthritis in the Cross River Basin
area of south-south Nigeria. Patients
and Methods: A retrospective
analysis of 43 patients who presented with septic arthritis in 45 joints between
September 2007 and August 2010.
All patients with pain, fever, joint swelling and non-weight bearing/refusal to
move the limb and had a joint aspiration productive of a turbid and/or purulent aspirate were included in the
analysis. Patients whose joint aspiration produced frank blood or a clear
exudate were excluded. Results: There were 24 males and 19 females
(M:F = 1.3:1). Forty patients
were children while three were
adults. Thirty-three patients were urban dwellers, 8 were semi-urban dwellers
and 2 were rural dwellers. Twenty-five
children were first seen by a Paediatrician. Only 5 patients were first
seen by an Orthopaedic surgeon. Definitive treatment was conservative in 28 children and arthrotomy/washout in
12 children and 3 adults. Staphylococcus
aureus was the commonest isolated pathogen in both age groups. Conclusion: Injudicious interventions in musculoskeletal conditions consist not only of traditional bone setting and other unorthodox
practices, but also sub-optimal orthodox medical practices. Healthcare outcomes in Africa are a function of the skewed distribution of the healthcare workforce and a weak referral
chain. The near absence of follow-up culture underscores the need for education
on injudicious antibiotic therapy to be directed at patients and physicians.
Judicious interventions in musculoskeletal sepsis at first contact and a
strengthening of the referral chain are important.