Purpose
Although aspiration of septic olecranon bursitis is recommended in the literature,
no high-level evidence exists to support this practice. The purpose of this study
was to retrospectively compare the results of traditional bursal aspiration (TBA)
with empirical management without aspiration (EM). We hypothesized that EM of uncomplicated
septic olecranon bursitis results in resolution, with fewer chronic draining sinuses
and less progression to bursectomy.
Methods
We performed a retrospective review of all cases of septic olecranon bursitis seen
by the orthopedic surgery department at a single tertiary referral center over a 5-year
period. Cases were manually reviewed to determine patient demographics, management,
and treatment results. The primary outcome was success of nonsurgical management versus
requirement for surgical bursectomy.
Results
Thirty cases of uncomplicated septic olecranon bursitis were identified within the
study period. Eleven patients were initially managed with TBA (performed by an emergency
or primary care physician prior to orthopedic consultation), resulting in 11 positive
cultures. Only 1 of these prompted a change of antibiotic management, and despite
this information, 5 patients required a second course of antibiotics for incomplete
resolution. Eight of the TBA cases went on to bursectomy. Nineteen patients underwent
EM. Sixteen of these cases resolved with a single course of empirical antibiotics,
and 3 (16%) cases required a second antibiotic course. One patient had a recurrence
of symptoms 2 months after resolution with a single course of empirical antibiotics.
This resolved with a second course of oral antibiotics. No patients who underwent
EM went on to require bursectomy. The number needed to harm when aspiration was performed
was 1.46.
Conclusions
We found EM of uncomplicated septic olecranon bursitis to be effective. Although 1
recurrence did occur in the EM group, no other complications occurred. Empirical management
without aspiration may be considered in cases of uncomplicated septic olecranon bursitis.
Type of study/level of evidence
Therapeutic IV.
Key words
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Article info
Publication history
Published online: August 14, 2019
Accepted:
June 26,
2019
Received:
June 19,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. The views expressed in this manuscript are those of the authors and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the US Government.
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© 2019 by the American Society for Surgery of the Hand. All rights reserved.
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