BACKGROUND
Successful treatment of septic arthritis of the shoulder in children relies on early diagnosis, immediate washout of the joint and appropriate antibiotic treatment. We present a minimally invasive technique for the washout of the septic shoulder.
OPERATIVE TECHNIQUE
The operation is performed under general anaesthesia with the use of an image intensifier. The child is positioned supine with the shoulder on a transparent arm board. Gentle longitudinal traction is performed by an assistant in order to increase the joint space. Two wide-bore cannulae are inserted into the joint anteriorly 2cm apart (Fig 1). Pus is aspirated and sent for microbiologic and microscopic assessment. Joint entry is confirmed by radiopaque dye injection (Fig 2). The trocar is removed leaving the plastic sheath inside the joint.
Figure 1.
Wide-bore cannulae inserted into the joint anteriorly 2cm apart
Figure 2.
Joint entry confirmed by radiopaque dye injection
One of the portals is used for washout and the other for suction until the fluid is clear. The washout is performed in stages interrupted by passive manipulation of the joint throughout the range of motion to ensure complete washout of all compartments of the joint. Finally, suction is connected to the outgoing cannula after removal of the ingoing one to ensure removal of all the remaining fluid.
DISCUSSION
Minimally invasive shoulder washout is a reliable, safe, quick and effective technique, which is not technically demanding. It is recommended as an initial procedure. The surgeon should have the expertise to perform a traditional arthroscopic or open washout if this technique fails for technical reasons or in the presence of thick pus.