TRAUMA SURGERY Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm Sebastian F. Baumbach • Christopher M. Lobo • Ilias Badyine • Wolf Mutschler • Karl-Georg Kanz Received: 27 November 2012 Ó Springer-Verlag Berlin Heidelberg 2013 Abstract Purpose Olecranon bursitis and prepatellar bursitis are common entities, with a minimum annual incidence of 10/100,000, predominantly affecting male patients (80 %) aged 40–60 years. Approximately 1/3 of cases are septic (SB) and 2/3 of cases are non-septic (NSB), with sub- stantial variations in treatment regimens internationally. The aim of the study was the development of a literature review-based treatment algorithm for prepatellar and olecranon bursitis. Methods Following a systematic review of Pubmed, the Cochrane Library, textbooks of emergency medicine and surgery, and a manual reference search, 52 relevant papers were identified. Results The initial differentiation between SB and NSB was based on clinical presentation, bursal aspirate, and blood sampling analysis. Physical findings suggesting SB were fever [ 37.8 °C, prebursal temperature difference greater 2.2 °C, and skin lesions. Relevant findings for bursal aspirate were purulent aspirate, fluid-to-serum glu- cose ratio \ 50 %, white cell count [ 3,000 cells/ll, poly- morphonuclear cells [ 50 %, positive Gram staining, and positive culture. General treatment measures for SB and NSB consist of bursal aspiration, NSAIDs, and PRICE. For patients with confirmed NSB and high athletic or occupa- tional demands, intrabursal steroid injection may be per- formed. In the case of SB, antibiotic therapy should be initiated. Surgical treatment, i.e., incision, drainage, or bursectomy, should be restricted to severe, refractory, or chronic/recurrent cases. Conclusions The available evidence did not support the central European concept of immediate bursectomy in cases of SB. A conservative treatment regimen should be pursued, following bursal aspirate-based differentiation between SB and NSB. Keywords Olecranon Á Prepatellar Á Bursitis Á Bursectomy Á Bursal aspiration Introduction There are more than 140 bursae within the human body [83]. Bursae are closed sacs lined by a synovial membrane providing almost frictionless motion between two tissue layers. Bursae develop after birth, most likely in response to movement and function [4, 12]. In the literature, olec- ranon and prepatellar bursitides were usually considered similar conditions, which is also the case in this paper. Bursitis accounts for approximately 1–12 cases per 10,000 hospitalizations with a reported minimum population annual incidence of 10/100,000. More than 80 % of all bursitis patients are male, aged 18–88 years, clustering at 40–60 years [11, 40, 43, 55, 56, 66, 68, 72]. Approximately 2/3 are non- septic cases and septic olecranon bursitis occurs four times as often as septic prepatellar bursitis [31, 40, 50, 70]. Non-septic bursitis (NSB) is a sterile inflammation that develops secondary to acute, occupational, or recreational trauma, crystal deposition (gout, pseudogout), or systemic S. F. Baumbach (&) Á W. Mutschler Á K.-G. Kanz Department of Trauma Surgery, University of Munich, LMU, Nussbaumstrasse 20, 80336 Munich, Germany e-mail: Sebastian.Baumbach@med.uni-muenchen.de C. M. Lobo Department of Trauma Surgery Vienna, Medical University of Vienna, Wa ¨hringergu ¨rtel 9, 1090 Vienna, Austria I. Badyine Ludwig-Maximilians University, Munich, Germany 123 Arch Orthop Trauma Surg DOI 10.1007/s00402-013-1882-7