Arch Hand Microsurg.  2020 Sep;25(3):189-200. 10.12790/ahm.20.0038.

Surgical Outcomes of Bacterial Infection of the Finger Bone and Joint

Affiliations
  • 1Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Republic of Korea

Abstract

Purpose
This study aimed to describe the surgical outcomes of bacterial infection of the finger bone and joint.
Methods
We retrospectively reviewed 31 cases of finger bone and joint bacterial infection from December 2016 to December 2019. Demographic information, finger infection details, treatment details, and range of motion (ROM) at the last follow-up were analyzed.
Results
Twenty (64.5%) of the 31 cases showed normal values in preoperative erythrocyte sedimentation rate and C-reactive protein level. Staphylococcus aureus (15 cases) was the most common pathogen. For the initial operative treatments, 21 cases were treated with incision and debridement with bone curettage or drilling, and seven with amputation. Seventeen patients underwent delayed wound closure after the initial surgery, of whom 16 did not have recurrent infections after wound closure. The mean number of operations was 2.1±1.3 in all cases. The median ROM of the involved finger was 57.7% (range, 26.9%–76.9%) and 88.8% (range, 34.6%–100%) of the contralateral side in the patients with and without initial septic arthritis, respectively (p=0.002). Twenty-nine cases (93.5% of 31 cases) showed no infection recurrence after completion of the treatments.
Conclusion
Combined antibiotic and surgical treatments showed a high cure rate, but initial septic arthritis was a poor prognostic factor of ROM. The soft tissue condition of the involved finger is important for deciding the surgical treatment.

Keyword

Fingers; Osteomyelitis; Infectious arthritis; Amputation; Arthrodesis

Figure

  • Fig. 1. Flowchart describing the surgical treatment of bacterial infection of the finger bone and joint. a)Antibiotics mixed cement was packed in some cases with bone defect.

  • Fig. 2. A 52-year-old woman visited our clinic with bone and joint infection in her right second finger after a dog bite (A and B). Incision and debridement were performed initially, and daily operation wound irrigation was performed for a week without wound closure (C and D). After granulation tissue growth (E), the extensor tendon and wound were sutured, and finger range of motion exercise was advocated (F and G). At the last follow-up, the infection did not recur, and the total range of motion of the second finger was 200° (H and I).

  • Fig. 3. A 57-year-old man visited our clinic with an unhealed open wound on his right thumb after undergoing operation for a nail bed injury, which he incurred during cooking (A and B). Incision and curettage were performed initially, followed by daily irrigation of the surgical wound (C and D). Then, antibiotics mixed cement was packed with temporary artificial nail application (E and F). At the last follow-up, the nail had grown well, and range of motion of the thumb was similar with that of the contralateral thumb (G and H).

  • Fig. 4. A 27-year-old man visited our clinic with an unhealed open wound on his right third finger after an injury during cooking (A). Incision and debridement were performed initially, and tenodermodesis was performed at the distal interphalangeal joint with temporary fixation (B-E). However, active bone and joint infection occurred at the operation site. Incision and curettage were performed, followed by daily irrigation of the surgical wound (F and G). After confirming no bacterial growth in the wound, arthrodesis with an autogenous bone graft was performed (H-J). However, the infection recurred, and the finger was amputated (K-M).

  • Fig. 5. A 58-year-old man visited our clinic with color change and pain in his left third finger (A-C). As more than half of the soft tissue of the distal phalanx was involved, we performed early open amputation (D). At the last follow-up, the range of motion of the remaining joint was well preserved (E and F).


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