[Tuberculosis of the wrist. Symptoms and outcome in eleven cases].
OBJECTIVE
We present our experience with a rare localization of tuberculosis, the wrist, focusing on symptoms and outcome after treatment.


METHODS
Our series included eleven patients, eight men and three women, mean age 42 Years, who presented tuberculosis of the wrist. Tuberculosis was known in four patients who were being treated and a context of tuberculosis was recognized in three others. One patient on long-term corticosteroid therapy was immunodepressed. Mean time from symptom onset to consultation was fifteen months indicating a slow and progressive disease process. An inflammatory syndrome was noted in nine patients. Based on the standard x-rays, the David-Chausse classification was: stage I n=1; stage II n=1; stage III n=3; stage IV n=4. The AP view of the wrist was normal in two patients. Diagnosis of tuberculosis was confirmed on the surgical biopsy specimen which revealed epithelio-gigantocellulary granuloma with caseous necrosis. In only five patients Koch bacilli developed in culture on Lowenstein-Jensen. Patients were given anti-tuberculous antibiotics and the wrist was immobilized in a plaster splint.


RESULTS
Mean follow-up was two years. The disease course was blunted by the antituberculosis treatment. Surgical drainage was only required to clear abscesses. Wrist stiffness was frequent and had a significant functional impact.


CONCLUSIONS
These eleven cases of a rare localization of tuberculosis illustrate the slow progressive course of clinical symptoms and radiological signs of tuberculosis, emphasizing the difficulties encountered in establishing early diagnosis of such isolated non-abscessed localizations. Anti-tuberculous treatment is effective but the functional outcome depends on early diagnosis before the development of radiological evidence of joint destruction.
Benchakroun
M
M
Clinique Chirurgicale de Traumatologie-Orthopédie, Hôpital Avicenne, CHU Ibn Sina, Rabat, Maroc. benchakrounmohammed@hotmail.com
El Bardouni
A
A
Zaddoug
O
O
Kharmaz
M
M
El Yaacoubi
M
M
Ouadghiri
M
M
El Manouar
M
M
D000038:Abscess / Q000145:classification / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D001706:Biopsy; D002348:Carpal Bones; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018450:Disease Progression; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016059:Range of Motion, Articular; D012720:Severity of Illness Index; D013165:Splints; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014375:Tuberculoma / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D014394:Tuberculosis, Osteoarticular / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D014955:Wrist Joint
D000995:Antitubercular Agents