Wrist with Synovial White Blood Cells: Septic Versus Suspected Infectious Arthritis

Purpose: Accurate diagnosis of acute painful swollen wrists can be difficult. We aimed to identify the differentiating clinical and laboratory parameters for septic and suspected infectious arthritis of the wrist. Methods: This retrospective study reviewed and compared the data of 49 patients (55 wrists) with synovial fluid white blood cell (WBC) counts [Formula: see text]20,000/mm3. 25 patients with 29 septic wrists with positive staining or culture results, and 24 patients with 26 suspected infectious wrists. Results: Patients with suspected infection underwent fewer operations (1.0 versus 2.1 times) and required shorter periods of hospitalization (34.0 versus 49.7 days) than those with septic wrists. C-reactive protein (CRP) levels before treatment, and postoperative day five for suspected infectious arthritis were lower than those for septic arthritis. Diabetes was more prevalent in patients with septic arthritis (13/25) than those with suspected infection (2/24). However, the average synovial WBC count and average highest temperature before treatment were not different between the two groups. Conclusions: Patients with suspected infectious wrists had lower initial CRP levels and a lower prevalence of diabetes. However, the initial synovial WBC count and body temperature were similar, implying that the initial management of suspected arthritis should be similar to that of septic arthritis.