Treatment of spinal epidural abscess has been based on surgical debridement. Medical treatment with antibiotics has been proposed as an alternative, but data on its efficacy are limited. The purpose of this study was to determine the early clinical outcome of medical treatment. This is a retrospective review of 52 patients with a spinal epidural abscess who were treated at our institution. Medical treatment was selected if no systemic sepsis was present and the neurologic examination was normal or stable (radiculopathy or signs of partial cord compression present for more than 72 hours before admission without deterioration). Twenty-nine patients had medical treatment and 23 patients were treated surgically. Medical treatment resulted in good or excellent early neurologic outcome in 24 of 29 patients (83%) at a median followup of 2 months. Three patients (11%) had failed medical treatment and required surgery and one patient (3%) who had severe comorbidities died. Staphylococcus aureus was the most common infectious pathogen, isolated in 28 of 36 positive cultures (78%). Medical treatment is a viable alternative to surgery for selected patients with a spinal epidural abscess. However, close clinical followup is essential and surgical decompression should be done when neurologic deterioration or development of systemic sepsis is observed. Level of Evidence: Therapeutic study, Level IV-1 (case series). See the Guidelines for Authors for a complete description of levels of evidence.

Septic arthritis of the shoulder, elbow, or wrist is not commonly described in the literature. We evaluated the micro- biology of these infections and the diagnostic role of joint aspirate findings. This retrospective study includes 52 patients, diagnosed from 1994 to 2004, with septic arthritis of the shoulder (n = 17), elbow (n = 23), or wrist (n = 12). The mean age was 44.3 years, and 54% of patients (28/52) had comorbidities. The prevalence of Staphylococcus aureus was 76%. Ninety-six percent of aspirates with positive cultures had a polymorphonuclear differential count greater than 85% of the total aspirate white blood cell count. Staphylococcus aureus is the most prevalent organism. A high index of suspicion for septic arthritis is necessary for all patients with upper extremity joint complaints, irrespective of age and medical status. The joint aspirate differential white blood cell count may be helpful in the diagnosis. Level of Evidence: Level IV, observational study. See Guidelines for Authors for a complete description of levels of evidence.

The most common pathogen of these infections, the infection recurrence rate, and the amputation rate. We retrospectively reviewed 26 patients of a mean age of 43 years with infections following operative treatment of ankle fractures. Twenty-one of 26 patients (81%) were compromised hosts according to the Cierny-Mader classification. Patients presenting up to 10 weeks postoperatively were treated by débridement and either hardware retention (if implants were judged stable) or hardware removal (if implants were loose). All patients presenting more than 10 weeks postoperatively underwent débridement and hardware removal, with the exception of one patient who underwent below knee amputation. Staphylococcus aureus was identified in 17 patients (65%) and was oxacillin-resistant in six (23%). The infection recurred in five of 18 patients who were followed up for 8 months on average. Three recurrent infections were controlled with repeat débridement. The remaining two patients underwent below-knee amputation, resulting in amputations in 3 of 18 patients. Infection after operative treatment of ankle fractures is a limb-threatening complication, especially in patients with comorbidities, such as diabetes mellitus. Treatment is challenging with high infection recurrence and amputation rates. Level of Evidence: Level IV, therapeutic study case series. See the Guidelines for Authors for a complete description of levels of evidence....