Overview
Infection complicating a splinter or foreign body in the shoulder can progress to deep periprosthetic or native joint infections requiring surgical intervention, often including the use of antibiotic spacers in a two-stage reimplantation process. 1Diagnosis
Clinical signs of infection including redness, swelling, warmth, and pain around the shoulder.
Positive cultures from aspiration or surgical samples to identify the causative organism.
Radiographic imaging (X-ray, MRI) to assess extent of infection and involvement of joint structures.
Elevated inflammatory markers (CRP, ESR) indicative of systemic infection. 1Management
First-line Treatment: Surgical removal of the foreign body and debridement of infected tissue. 1
Antibiotic Spacer: Implantation of an anatomic intraoperatively molded antibiotic cement spacer for two-stage treatment. 1
Rehabilitation: Early motion exercises allowed if rotator cuff is intact, potentially improving functional outcomes and pain scores. 1
Antibiotic Selection: Customized based on intraoperative preparation and culture sensitivities, though specific drug classes/doses are not detailed in the abstract. 1Special Populations
No Specific Data: The provided abstracts do not cover management specifics for pregnancy, pediatrics, elderly, or comorbidities related to shoulder infections with splinters. 1Key Recommendations
Utilize an anatomic intraoperatively molded antibiotic cement spacer for two-stage treatment of shoulder infections to achieve high eradication rates (85% in this study). (Evidence: Moderate) 1
Consider early initiation of motion exercises post-spacer implantation if the rotator cuff is intact to enhance functional outcomes and reduce pain. (Evidence: Moderate) 1
Tailor antibiotic selection for the spacer based on intraoperative assessment and culture results to optimize efficacy. (Evidence: Expert opinion) 1References
1 Aibinder WR, Lee J, Shukla DR, Cofield RH, Sanchez-Sotelo J, Sperling JW. An Anatomic Intraoperatively Prepared Antibiotic Spacer in Two-Stage Shoulder Reimplantation for Deep Infection: The Potential for Early Rehabilitation. Orthopedics 2019. link